两例宫内输血后 Rh 同种免疫孕妇胎儿血管多普勒测量值与胎儿贫血的相关性。

Correlation of fetal blood vessel Doppler measurements with fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions.

机构信息

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Int J Gynaecol Obstet. 2019 Aug;146(2):218-222. doi: 10.1002/ijgo.12825. Epub 2019 May 7.

DOI:10.1002/ijgo.12825

PMID:31004522

Abstract

OBJECTIVE

To assess the correlation between fetal blood vessel Doppler measurements and fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions as a potential guide to therapy.

METHODS

A prospective observational study was conducted among 30 women who attended a single hospital in India between April 2, 2015 and October 30, 2016. The participants underwent a third intrauterine transfusion based on a middle cerebral artery (MCA) peak systolic velocity (PSV) of greater than 1.50 multiples of the median (MoM). Cordocentesis was performed before the third intrauterine transfusion and hematocrit values correlated with the blood vessel Doppler measurements.

RESULTS

The MCA PSV MoM and fetal hematocrit MoM had a correlation coefficient of -0.43 (95% confidence interval -0.68 to 0.08; P=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value were 68%, 57%, 83%, and 33%, respectively. The descending aorta PSV δ and fetal hematocrit δ had a correlation coefficient of -0.54 (95% confidence interval -0.75 to -0.23; P=0.001). An area under the curve of 0.80 (standard error 0.085; P=0.017) had 87% sensitivity and 57% specificity for diagnosing fetal anemia.

CONCLUSION

The descending aorta PSV could offer a useful diagnostic adjunct to MCA PSV after two intrauterine transfusions.

摘要

目的

评估两次宫内输血后 Rh 同种免疫妊娠胎儿血管多普勒测量值与胎儿贫血之间的相关性，以期为治疗提供指导。

方法

这是一项在印度的一家医院进行的前瞻性观察性研究，研究对象为 2015 年 4 月 2 日至 2016 年 10 月 30 日期间就诊的 30 名女性。根据大脑中动脉（MCA）收缩期峰值速度（PSV）大于 1.50 中位数倍数（MoM），对这些患者进行第三次宫内输血。在第三次宫内输血前进行脐静脉穿刺，将血细胞比容值与血管多普勒测量值相关联。

结果

MCA PSV MoM 与胎儿血细胞比容 MoM 的相关系数为-0.43（95%置信区间-0.68 至 0.08；P=0.017）。灵敏度、特异度、阳性预测值和阴性预测值分别为 68%、57%、83%和 33%。降主动脉 PSV δ与胎儿血细胞比容 δ的相关系数为-0.54（95%置信区间-0.75 至-0.23；P=0.001）。曲线下面积为 0.80（标准误差 0.085；P=0.017），对胎儿贫血的诊断具有 87%的灵敏度和 57%的特异度。