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Babkova A, Rob L, Kubecova M, Hruda M, Halaska MJ. Middle cerebral artery peak systolic velocity monitoring of fetal anemia during chemotherapy in pregnancy. Acta Obstet Gynecol Scand 2024; 103:660-668. [PMID: 38226422 PMCID: PMC10993339 DOI: 10.1111/aogs.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Chemotherapy during pregnancy can increase the risk of fetal anemia. Severe fetal anemia can lead to the development of hydrops fetalis and potentially fetal demise. Hence, it is imperative to implement consistent monitoring methods in the context of chemotherapy treatment. This study aimed to diagnose and monitor fetal anemia using middle cerebral artery peak systolic velocity (MCA-PSV) as a diagnostic tool during chemotherapy in pregnant women. MATERIAL AND METHODS The study employed a prospective analysis involving a case series of 15 patients diagnosed with cancer during pregnancy and subsequently underwent chemotherapy. MCA-PSV was used to identify fetal anemia. The patients were scheduled for ultrasound examinations of the MCA-PSV. The first examination was performed on the same day as the administration of chemotherapy, while the second occurred on the 10th day after chemotherapy. The measurement technique used in the study was based on the methodology proposed by Mari and Barr. The multiples of the median were calculated using the calculators provided by Medicina Fetal Barcelona. Based on these values anemia severity was determined. When moderate or severe anemia was identified, chemotherapy was individually modified. Additionally, a blood count analysis was conducted immediately after the delivery of the newborn. RESULTS Five patients were diagnosed with fetal or newborn anemia. With MCA-PSV, we identified moderate fetal anemia in two patients and severe fetal anemia in one. The complete blood count testing of newborns revealed mild anemia in three patients. One case was unrelated to chemotherapy-induced anemia. During treatment, fetal anemia did not corelate with maternal anemia. CONCLUSIONS In four cases of anemia the combination of cisplatin and iphosphamide was used as a chemotherapy agent. No anemia was observed in other drug combinations. Our findings suggest that MCA-PSV is a reliable method for identifying anemia and should be included in the treatment protocol for chemotherapy-induced fetal anemia.
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Affiliation(s)
- Anna Babkova
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Lukas Rob
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Martina Kubecova
- Department of OncologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Martin Hruda
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
| | - Michael J. Halaska
- Department of Obstetrics and GynecologyUniversity Hospital Kralovske Vinohrady, Third Medical Faculty, Charles University in PraguePragueCzech Republic
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Diagnostic Performance of Doppler Ultrasonography for the Detection of Fetal Anemia: A Meta-analysis. Ultrasound Q 2020; 35:339-345. [PMID: 31166294 DOI: 10.1097/ruq.0000000000000450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluates the diagnostic performance of Doppler ultrasound in diagnosing fetal anemia. Data were taken from relevant study reports published in peer-reviewed journals identified after a literature search in electronic databases. Random effects meta-analyses were performed by pooling the effect sizes of diagnostic indices (sensitivity, specificity, positive/negative predictive values, and false-positive rate) or correlation coefficients reported by individual studies. As a result, 31 studies (1848 pregnancies; gestation age, 28.25 weeks [95% confidence interval {CI}, 26.87-29.63]) were included in the meta-analysis. Anemia was found in 63.7% (95% CI, 49.7-77.7) fetuses, and severe anemia was found in 36.7% (95% CI, 26.9-46.4) fetuses. Sensitivity and specificity of Doppler ultrasound for detecting fetal anemia in alloimmunized fetuses at middle cerebral artery peak systolic velocity cutoff of 1.5 multiple of median for gestation age were 83.42% (95% CI, 71.75-95.09) and 80.30% (95% CI, 73.58-87.02), respectively. Positive predictive value, negative predictive value, and false-positive rate were 76.35% (95% CI, 65.98-86.72), 80.0% (95% CI, 76.63-83.37), and 10.4% (95% CI, 5.9-14.9), respectively. Correlation coefficient between hematological anemia and Doppler ultrasound-measured blood flow velocity was -0.706 (95% CI, -0.765 to -0.635; P < 0.00001). In conclusion, Doppler ultrasound-measured middle cerebral artery peak systolic velocity at 1.5 multiple of median provides good diagnostic strength for the detection of alloimmunized fetal anemia. A strong correlation between Doppler velocimetric measures and hematological anemia is also observed.
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Maternal Parvovirus B19 Infection Causing First-Trimester Increased Nuchal Translucency and Fetal Hydrops. Case Rep Obstet Gynecol 2019; 2019:3259760. [PMID: 31360565 PMCID: PMC6642751 DOI: 10.1155/2019/3259760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/12/2019] [Indexed: 12/03/2022] Open
Abstract
This is a case report of a 31-year-old primigravida who was diagnosed with an asymptomatic acute parvovirus B19 infection in the second trimester of pregnancy and its suspected association with an increased nuchal translucency (NT) measurement. Parvovirus B19 is a single-stranded DNA virus that is cytotoxic to erythroid progenitor cells, causing inhibition of erythropoiesis. While maternal disease is usually mild, fetal infection can result in spontaneous abortion, aplastic anemia, nonimmune fetal hydrops, and fetal demise. This fetus had an increased NT of 3.2 mm at 11 weeks' gestation with a normal male karyotype and microarray analysis on chorionic villi sampling, in addition to a normal fetal echocardiogram at 15 weeks' gestation. The anatomy scan at 20 weeks' and 1-day gestation revealed fetal ascites, pleural effusion, and increased middle cerebral artery peak systolic velocity suspicious for fetal anemia. At this time, maternal serology for parvovirus was positive for IgM and IgG. Amniocentesis, cordocentesis, and intrauterine transfusion were performed. The amniocentesis revealed elevated parvovirus B19 DNA, quantitative PCR (2,589,801 copies/mL, reference range <100 copies/mL). The patient delivered a viable male fetus at 37 weeks' and 6-day gestation, without sequelae of the previously noted hydrops. Parvovirus B19 infection should be a consideration when evaluating increased NT and hydrops fetalis. It warrants close antepartum surveillance and possible intrauterine fetal transfusions. With prompt recognition, proper treatment, and surveillance, these patients can go on to achieve healthy term deliveries. Long-term outcomes of delivered infants require further study.
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Mild-to-moderate foeto-maternal haemorrhage in the third trimester and at term of pregnancy: quantitative determination and clinical-diagnostic evaluation. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:302-306. [PMID: 28488965 DOI: 10.2450/2017.0316-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/02/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Foeto-maternal haemorrhage (FMH), a gestational event that occurs before or during delivery, consists of a loss of foetal blood into the maternal circulation. FMH occurs more frequently during the third trimester or labour both in normal and complicated pregnancies. In the case of alloimmunisation, the maternal immunological response and the severity of the resulting foetal or neonatal disease depend on the amount of foetal blood that passes into the maternal circulation. The aim of this study was to determine FMH in the third trimester and at term of pregnancy and to evaluate the role of clinical and ultrasound markers in the prediction of FMH. MATERIALS AND METHODS FMH was quantified by cytofluorimetric testing at 28 to 35 weeks of gestation in 223 women and at term in 465 women, all with risk factors. Foetal evaluation included foetal movement profile, middle cerebral artery peak velocity of systolic blood flow (MCA-PSV) and cardiotocographic monitoring. RESULTS All women tested negative for FMH in the third trimester. Four patients (0.9%) tested positive at term, with estimated volumes of bleeding of 2.2, 8.1, 12.3 and 39.8 mL. Three FMH cases (75%) had a non-reassuring cardiotocography compared to 8.9% (42/461) of women without FMH (p=0.003) and two FMH cases reported a reduction in foetal movements reduction compared to four of those without FMH (p=0.001). Mean MCA-PSV was normal in both the groups with and without FMH (p=0.22). DISCUSSION FMH is rare in pregnancy and at term. Cytofluorimetric testing is a specific method to detect mild-to-moderate FMH even when the MCA-PSV is not informative. Mild-to-moderate FMH is significantly associated with reduced foetal movements and non-reassuring cardiotocographic monitoring.
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A pilot study on peak systolic velocity monitoring of fetal anemia after administration of chemotherapy during pregnancy. Eur J Obstet Gynecol Reprod Biol 2013; 174:76-9. [PMID: 24439719 DOI: 10.1016/j.ejogrb.2013.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 11/24/2013] [Accepted: 12/13/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To monitor fetal anemia during administration of chemotherapy to the fetus's mother. STUDY DESIGN Between 2007 and 2012 six patients with malignancy diagnosed during pregnancy were included in our prospective study. For evaluation of fetal anemia, peak systolic velocimetry (PSV) of the middle cerebral artery is considered the best method. The patients were repeatedly examined one day before and on the third day after the administration of chemotherapy. At least three measurements were performed and the highest value was used as appropriate. Multiples of the median (MoM) were calculated using the website http://www.perinatology.com/calculators/MCA.htm. When the MoM reached 1.29, moderate anemia was diagnosed. RESULTS The women's average age was 30 years. The average gestational age at diagnosis was 20.7 weeks of pregnancy. Borderline fetal anemia was detected in only in one patient. After delivery newborns were examined by standard pediatric evaluation and blood count was provided. There was no evidence of any newborn anemia. CONCLUSIONS Chemotherapy administered during pregnancy is becoming more frequent due to increasing knowledge and data on such cases. Close monitoring of the fetus should be performed in specialized centers. For detection of chemotherapy-induced anemia, PSV measurement should be employed.
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Gwanmesia LM, Samii K, Boulvain M, Extermann P, Faigaux R, Fokstuen S. Elevated middle cerebral artery peak systolic velocity as a prenatal manifestation of heterozygous type 2 alpha-thalassemia. Eur J Obstet Gynecol Reprod Biol 2013; 167:235-6. [PMID: 23290248 DOI: 10.1016/j.ejogrb.2012.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/16/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
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In Utero diagnosis and management of a fetus with homozygous α-Thalassemia in the second trimester: a case report and literature review. J Pediatr Hematol Oncol 2011; 33:e358-60. [PMID: 22042285 DOI: 10.1097/mph.0b013e31821b368c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alpha thalassemia with the absence of 4 α-globin genes leads to fetal hydrops and fetal death from anemia. Historically considered a lethal condition, optimal in utero management of homozygous α-thalassemia is unclear. A fetus of Filipino descent at 26 weeks gestation presented with ultrasound evidence of anemia. Cordocentesis confirmed anemia and homozygous α-thalassemia (--/--). Intrauterine transfusion corrected anemia but fetal growth restriction and oligohydramnios persisted. Intrauterine exchange transfusion improved hemoglobin parameters, fetal growth, and oligohydramnios. The late preterm infant was delivered with classic limb reduction defects. Hemoglobin Bart's is nonfunctional for oxygen transport, and intrauterine exchange transfusion may be effective first-line therapy and further investigation is warranted.
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Degani S. Evaluation of fetal cerebrovascular circulation and brain development: the role of ultrasound and Doppler. Semin Perinatol 2009; 33:259-69. [PMID: 19631086 DOI: 10.1053/j.semperi.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human fetal brain is protected from pressure changes by autoregulation of the cerebral circulation. However, antenatal intrauterine cerebrovascular events are found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation provide a powerful tool for the evaluation of physiological and pathological hemodynamic events. Anatomic and physiological considerations of cerebral vasculature in healthy and disease states are relevant in studying brain development and variations in fetal brain blood perfusion. The major role of ultrasound and Doppler modalities in the evaluation of fetal cerebrovascular circulation is enabled by implementation of these considerations. Changes in flow characteristics in fetal cerebral vasculature can be used for clinical decision making in situations of fetal compromise, such as growth restriction and anemia.
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Affiliation(s)
- Shimon Degani
- Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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Maciuleviciene R, Gaurilcikas A, Simanaviciute D, Nadisauskiene RJ, Gintautas V, Vaitkiene D, Baliutaviciene DK. Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization. J Matern Fetal Neonatal Med 2009; 21:361-5. [DOI: 10.1080/14767050802037787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carrier Screening for Thalassemia and Hemoglobinopathies in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:950-959. [DOI: 10.1016/s1701-2163(16)32975-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Langlois S, Ford JC, Chitayat D, Langlois S, Chitayat D, Désilets VA, Farrell SA, Geraghty M, Nelson T, Nikkel SM, Skidmore D, Shugar A, Wilson RD, Johnson JA, Audibert F, Allen VM, Gagnon A, Langlois S, Blight C, Désilets VA, Wyatt PR. Dépistage des porteurs de thalassémie et d’hémoglobinopathies au Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008. [DOI: 10.1016/s1701-2163(16)32976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rigal D, Meyer F, Mayrand E, Dupraz F. Les allo-immunisations fœto-maternelles anti-érythrocytaires : état de l’art en 2008. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1773-035x(08)71784-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maguire K, Johnson A, Ou CN, Lantin RL, Moise KJ. Elevated middle cerebral artery peak systolic velocity without fetal anemia in a case of homozygous α–thalassemia-1. Prenat Diagn 2008; 28:72-4. [DOI: 10.1002/pd.1914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Morel O, Chagnaud S, Laperrelle J, Clément D, Malartic C, Akerman G, Tulpin L, Sitbon M, Barranger E. Parvovirus B19 et grossesse : revue de la littérature. ACTA ACUST UNITED AC 2007; 35:1095-104. [DOI: 10.1016/j.gyobfe.2007.07.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 07/04/2007] [Indexed: 11/16/2022]
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Valsky DV, Daum H, Yagel S. Reversal of mirror syndrome after prenatal treatment of Diamond-Blackfan anemia. Prenat Diagn 2007; 27:1161-4. [PMID: 17828794 DOI: 10.1002/pd.1840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kempe A, Rösing B, Berg C, Kamil D, Heep A, Gembruch U, Geipel A. First-trimester treatment of fetal anemia secondary to parvovirus B19 infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:226-8. [PMID: 17252527 DOI: 10.1002/uog.3925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Here we report two cases of first-trimester parvovirus B19 (PV-B19) infection that were successfully treated by intrauterine blood transfusion into the umbilical vein. At 13 weeks' gestation both fetuses presented with increased nuchal translucency (NT) and cardiomegaly. In both cases pulsed Doppler ultrasound examination of the fetal middle cerebral artery (MCA) revealed increased peak systolic velocity (PSV), which led to a suspicion of fetal anemia. Maternal PV infection was confirmed by a positive polymerase chain reaction result. Each fetus received a 3-mL intravenous transfusion of packed red blood cells into the umbilical vein, using a 25-G spinal needle. Follow-up ultrasound and Doppler examination demonstrated fetal well-being, decline of the MCA-PSV and resolution of the NT. Case 1 was readmitted at 25 weeks' gestation with severe hydrops fetalis, and both mother and fetus still tested positive for PV-B19 DNA. Three more intrauterine blood transfusions were performed and the fetal hydrops resolved. In Case 2 no additional transfusions were needed. Both babies had a good neonatal outcome and uneventful follow-up. Our findings demonstrate that the MCA-PSV is helpful in establishing the diagnosis of first-trimester fetal anemia. Intravasal transfusion can be attempted as early as the first trimester.
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Affiliation(s)
- A Kempe
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Germany.
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Yamaguchi Y, Tsukimori K, Hojo S, Nakanami N, Nozaki M, Masumoto K, Taguchi T, Wake N. Spontaneous rupture of sacrococcygeal teratoma associated with acute fetal anemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:720-2. [PMID: 16958151 DOI: 10.1002/uog.3821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sacrococcygeal teratoma (SCT) is the most common congenital tumor, with affected fetuses having a high risk of perinatal complications and death. We report a case of a fetus with an SCT that developed acute anemia due to spontaneous rupture of the tumor in utero. The fetus was referred at 25 weeks' gestation for evaluation of a large solid and cystic mass in the sacral region. There were no signs of hydrops or placentomegaly. At 33 weeks' gestation, loss of variability in the fetal heart rate pattern was recorded. Doppler ultrasonography showed increased middle cerebral artery peak systolic velocity, suggesting fetal anemia. Markedly bloody amniotic fluid, with 82% hemoglobin F, was observed on amniocentesis, suggesting rupture of the SCT with active fetal bleeding. An emergency Cesarean section was performed. At delivery, the tumor was bleeding actively and the neonatal hemoglobin concentration was 3.1 g/dL. There were no findings of hemorrhage or necrosis within the tumor. The neonate received a blood transfusion, and surgical resection of the tumor was carried out on the first day after delivery. Postoperatively, the baby did well. We suggest that fetal SCTs run the risk of inducing acute fetal anemia due to intrauterine hemorrhage of the tumor, a finding which could lead to an earlier and more appropriate management of this condition.
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Affiliation(s)
- Y Yamaguchi
- Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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