Middle cerebral artery blood flow in severe fetal hemolytic disease and multiple intrauterine blood transfusions


Дәйексөз келтіру

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Аннотация

Aim. To estimate the diagnostic performance of fetal middle cerebral artery peak systolic velocity (MCA-PSV) and AMCA>1.5 multiples of the median (MoM) to define indications for multiple intrauterine blood transfusions (IUT) in fetal hemolytic disease (FHD). Materials and methods. The study included 99 patients with moderate FHD (n = 4), FHD with severe neonatal jaundice (n = 74) and edematous FHD (n = 21). Forty, 28, and 31 patients received 3, 4, and 5-7 IUTs, respectively. The sensitivity of AMCA>1.5 MoM before IUT was estimated. Results. Measuring AMCA>1.5 MoM allows the assessment of anemia severity in severe FHD. Blood transfusion increases hemoglobin and hematocrit levels resulting in a reduction of MCA-PSV. But 7-20 days after IUT, the hemoglobin and hematocrit levels decrease again due to hemolysis, and MCA-PSV increases, which requires subsequent IUTs. The sensitivity of determining AMCA> 1.5 MoM before the 2nd IUT was 90.9%. Before 3d-6th IUT, the sensitivity of sensitivity of measuring AMCA>1.5 MoM decreased to 79.8%; 64.4%; 51.6% and 45.5%, respectively. Conclusion. An increase in MCA-PSV>1.5 MoM can be used as an indication for the first two IUTs. Indications for the third and subsequent IUTs should be based on calculating the expected rate of hematocrit reduction.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Alexander Konoplyannikov

N.I. Pirogov Russian National Research Medical University

Email: npo.med@gmail.com
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, Pediatric faculty

Lali Sichinava

N.I. Pirogov Russian National Research Medical University

Email: lalisichinava@gmail.com
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, Pediatric faculty

O. Panina

M.V. Lomonosov Moscow State University

Email: olgapanina@yandex.ru

Aleksandra Smirnova

Center for Family Planning and Reproduction, Moscow's health department

Email: salexandra2006_0@mall.ru
MD, Head of the Consulting and Diagnostic Department

Irina Naydenova

Center for Family Planning and Reproduction, Moscow's health department

Email: 4l43428@gmail.com
Obstetrician-Gynaecologist

Oleg Latyshkevich

N.I. Pirogov Russian National Research Medical University; Center for Family Planning and Reproduction, Moscow's health department

Email: latishkevich@mail.ru
Ph.D., Teaching Assistant at the Department of Obstetrics and Gynecology

Әдебиет тізімі

  1. Коноплянников А.Г., Павлова Н.Г. Изосерологическая несовместимость крови матери и плода. Гемолитическая болезнь плода и новорожденного. В кн.: Айламазян Э.К., Серов В.Н., Радзинский В.Е., Савельева Г.М., ред. Акушерство. Национальное руководство. M.: ГЭОТАР-Медиа; 2015: 324-34. [Konoplyannikov A.G., Pavlova N.G. Isoserological incompatibility of maternal and fetal blood. Hemolytic disease of the fetus and newborns. In: Aylamazyan E.K., Serov V.N., Radzinsky V.E., Savelyeva G.M., ed. Obstetrics: National Leadership. M: GEOTAR-Media Publ. 2015; 324-34. (in Russian)].
  2. Кравченко Е.Н., Ожерельева М.А., Куклина Л.В., Кропмаер К.П., Цыганкова О.Ю. Совершенствование алгоритма ведения беременных с резус иммунизацией: диагностические аспекты. Мать и дитя в Кузбассе. 2017; 4: 43-7. [Kravchenko E.N., Ozherelyeva M.A., Kuklina L.V., Kropmaer K.P., Tsygankova O.Yu. Improving the management of pregnant women with Rh immunization: diagnostic aspects. Mat' i ditya v Kuzbasse / Mother and child in Kuzbass. 2017; 4 (71): 43-7. (in Russian)].
  3. Савельева Г.М., Курцер М.А., Сичинава Л.Г., Коноплянников А.Г., Латышкевич О.А., Сонголова Е.Н. 50 лет иммунопрофилактике резус-иммунизации: на страже перинатальной заболеваемости и младенческой смертности (исторический экскурс). Акушерство и гинекология. 2018; 12: 177-83. [Savelyeva G.M., Kurtser M.A., Sichinava L.G., Konoplyannikov A.G., Latyshkevich O.A., Songolova E.N. 50 years of immunization with Rh immunization: on guard of perinatal morbidity and infant mortality (historical excursus). Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; 12: 177-83. (in Russian)]. https://dx.doi.org/10.18565/ aig.2018.12.177-183.
  4. Hassan M.Z., Iberahim S., Abdul Rahman W.S.W., Zulkafli Z., Bahar R., Ramli M. et al. Severe anti-D haemolytic disease of fetal and newborn in rhesus D negative primigravida. Malays J. Pathol. 2019; 41(1): 55-8.
  5. Абдрахманова Л.Р., Токтарова О.А., Ситарская М.В., Мусина Д.М. Анализ результатов ультразвукового допплерометрического исследования кровотока в средней мозговой артерии у плода при резус-иммунизации. Практическая медицина. 2015; 4-2: 7-9. [Abdrakhmanova L.R., Toktarova O.A., Sitarskaya M.V., Mysina D.M. Analysis of the results of ultrasonic doppler study of blood flow in the middle cerebral artery in the fetus with Rh-immunization. Prakticheskaya medicina / Practical medicine. 2015; 4-2 (89): 7-9. (in Russian)].
  6. Мамедалиева Н.М., Шарипбаева Н.Т., Данияров Н.Н., Джиджилава Г.М. Особенности течения беременности, родов и перинатальные исходы у пациенток с резус-сенсибилизацией. Вестник КазНМУ. 2015; 1: 18-21. [Mamedalieva N.M., Sharipbaeva N.T., Daniyarov N.N., Dzhidzhilava G.M. Features of the course of pregnancy, childbirth and perinatal outcomes in patients with Rh sensitization. Vestnik KazNMU / Bulletin of KazSMU. 2015; 1: 18-21. (in Russian)].
  7. Ghesquiere L., Houfflin-Debarge V., Behai H., Coulon C., Subtil D., Vaast P. et al. Should optimal timing between two intrauterine transfusions be based on estimated daily decrease of hemoglobin or on measurement of fetal middle cerebral artery peak systolic velocity? Transfusion. 2017; 57(4): 899-904. https:// dx.doi.org/10.1111/trf.13980. doi: 10.1111/trf.13980.
  8. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Obstet. Gynecol. 2018; 131(3): e.82-90.
  9. Dodd J.M., Andersen C., Dickinson J.E., Louise J., Deussen A., Grivell R.M. et al. Fetal middle cerebral artery Doppler to time intrauterine transfusion in redcell alloimmunization: a randomized trial. Ultrasound Obstet. Gynecol. 2018; 51(3): 306-12. https://dx.doi.org/10.1002/uog.18807.
  10. Morales Rosello J., Scarinci E., Sdnchez Ajenjo C., Santolaria Baig A., Gonzalez Martinez I.M., Canada Martinez A.J. et al. Unexpected middle cerebral artery peak systolic velocity values in the normal fetal population. Are they a matter of concern? J. Matern. Fetal Neonatal Med. 2020; 33(8): 1282-7. https:// dx.doi.org/10.1080/14767058.2018.1517322.
  11. Argoti P.S., Mari G. Fetal anemia. Minerva Ginecol. 2019; 71(2): 97-112. https://dx.doi.org/10.23736/S0026-4784.18.04334-4.
  12. Kennedy A.M., Woodward P.J. A radiologist's guide to the performance and interpretation of obstetric Doppler US. Radiographics. 2019; 39(3): 893-910. https://dx.doi.org/10.1148/rg.2019180152.
  13. Prefumo F., Fichera A, Fratelli N., Sartori E. Fetal anemia: Diagnosis and management. Best Pract. Res. Clin. Obstet. Gynaecol. 2019; 58: 2-14. https:// dx.doi.org/10.1016/j.bpobgyn.2019.01.001.
  14. Mari G., Deter R.L., Carpenter R.L., Rahman F., Zimmerman R., Moise K.J.Jr. et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N. Engl. J. Med. 2000; 342(1): 9-14. https://dx.doi.org/10.1056/NEJM200001063420102.
  15. Клинический протокол Министерства здравоохранения РФ от 18 мая 2017 г. N 15-4/10/2-330. О направлении клинических рекомендаций (протокола) «Резус-сенсибилизация. Гемолитическая болезнь плода». Available at: http://docs.cntd.ru/document/456085287 [The clinical Protocol of the Ministry of health of the Russian Federation from 18 may 2017 N 15-4/10/2-330. About the direction of clinical recommendations (Protocol) "RH-sensitization. Hemolytic disease of the fetus" (in Russian)].
  16. Bowman J.M. The management of Rh immunization. Obstet. Gynecol. 1978; 52(1): 1-16.
  17. Керимова Э.А., Путилова Н.В., Кинжалова С.В., Чистякова Г.Н. Динамика показателей врожденного и адаптивного иммунитета у плодов с гемолитической болезнью, обусловленной резус-конфликтом, перенесших однократное внутриутробное внутри сосудистое переливание крови. Российский вестник акушера-гинеколога. 2018; 18(1): 15-8. [Kerimova E.A. Putilova N.V., Kinzhalova S.V., Chistyakova G.N. Dynamics of indicators of innate and adaptive immunity in fetuses with hemolytic disease due to Rhesus conflict after a single intrauterine intravascular blood transfusion. Rossiiskii vestnik akushera-ginekologa/Russian Bulletin of obstetrician-gynecologist. 2018; 18 (1): 15-8. (in Russian)]. https://doi.org/10.17116/ rosakush201818115-18.
  18. Babovic I., Plesinac S., Sparic R., Dotlic J., Pilic I., Nejkovic L., Plecas D. Fetal hydrops and middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for therapy. Clin. Exp. Obstet. Gynecol. 2017; 44(3): 423-8.
  19. Babovic I., Plesinac S., Radojicic Z., Antonovic O., Sparic R., Plecas D., Radunovic N. Middle cerebral artery Doppler in prediction degree of fetal anemia and the best timing for the second intrauterine intravascular transfusion in red cell alloimmune disease. Clin. Exp. Obstet. Gynecol. 2015; 42(6): 792-6.
  20. Friszer S., Maisonneuve E., Mace G., Castaigne V., Cortey A., Mailloux A. et al. Determination of optimal timing of serial in-utero transfusions in red-cell alloimmunization. Ultrasound Obstet. Gynecol. 2015; 46(5): 600-5. https:// dx.doi.org/10.1002/uog.14772.
  21. Welch R., Rampling M. W., Anwar A., Talbert D. G., Rodeck C.H. Changes in hemorheology with fetal intravascular transfusion. Am. J. Obstet. Gynecol. 1994; 170(3): 726-32. 10.1016/s0002-9378(94)70271-3.
  22. Scheier M., Hernandez-Andrade E., Fonseca E.B., Nicolaides K.H. Prediction of severe fetal anemia in red blood cell alloimmunization after previous intrauterine transfusions. Am. J. Obstet. Gynecol. 2006; 195(6): 1550-6. https:// dx.doi.org/10.1016/j.ajog.2006.03.060.
  23. Керимова Э.А., Путилова Н.В., Чистякова Т.Н., Пестряева Л.А., Устьянцева Н.Ю. Клинико-иммунологическое обоснование внутриутробных гемотрансфузий при гемолитической болезни плода по системе резус. Акушерство и гинекология. 2016; 12: 24-7. https://doi.org/10.18565/ aig.2016.12.24-7. [Kerimova E.A. Putilova N.V., Chistyakova G.N., Pestryaeva L.A., Ustyantseva N.Yu. Clinical and immunological substantiation of intrauterine blood transfusions with hemolytic disease of the fetus according to the rhesus system. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2016; 12: 24-7. (in Russian)]. https://doi.org/10.18565/aig.2016.12.24-7.
  24. Макогон А.В., Андрюшина И.В. Диагностика и лечение гемолитической болезни плода. Акушерство и гинекология. 2012; 1: 43-8. [Makagon A.V., andriushina I.V. Diagnostics and treatment of fetal hemolytic disease. Akusherstvo i Ginekologiya / Obstetrics and Gynecology. 2012; 1: 43-8 (in Russian)].

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