Application and Effectiveness of Mca-Psv on the Detection and the Diagnosis of the Fetal Anemia - Paper Example

Studies on the application and effectiveness of middle cerebral artery- peak systolic velocity MCA-PSV on the detection and the diagnosis of the fetal anemia was considered in the systematic review. Each study was considered as an independent case for analysis since they applied different sets of participants for instance, in the control and treatment groups.

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The first survey to be reviewed was interested in establishing the fetal anemia in the pregnancies that has been complicated by the blood group immunization from the maternal side, though the Doppler measurements. This study assessed 158 fetuses, where 135 exhibited a standard value for middle cerebral artery- peak systolic velocity and 23 fetuses who showed a risk of becoming anemic. The two groups were labeled as A and B, and a prospective study was designed from the group B and was labeled group C., but the general survey embraced a retrospective study design. Menstrual history as confirmed by the sonographic fetal biometry was used to determine the age of the fetus that was to be placed in the survey. For all participant, a mean of 28.9 weeks and a standard deviation of (+/-) 7.2 weeks was considered for inclusion in the study. The group B participants had 23 fetuses who were scheduled for 56 cardiocenteses (Mari, Adrignolo, Abuhamad, Pirhonen, Jones, Ludomirsky, and Copel, 1995). Group C has 16 fetuses planned for 42 cardiocenteses, who were also vulnerable to fetus anemia. The receiver operating characteristic was used to determine the cut-off point that was utilized in distinguishing between the fetus which suffered from anemia and those that did not have anemia issues, in the group B by the application of the middle cerebral artery- peak systolic velocity. Data from group A was used to come up with a test for establishing fetal anemia for group B by the use of velocity. Data from group A and B were used to develop a test based on the velocity to determine fetal anemia for group C participants.

In a different study, middle cerebral artery- peak systolic velocity was considered as a non-invasive method to assess the severity of fetal anemia. The invasive methods such as amniocentesis, are associated with various complications such as fetal bleeding and rupture of the membrane and subsequent loss of the fetus making it a necessity for coming up with a method that overrides all the above complication. Studies have revealed the effectiveness of the Doppler measurements of the peak systolic velocity related to the fetuss middle cerebral artery, to have a correlation with the severity of anemia. The study was carried out by sampling the blood of 66 fetuses and performed on 20 singleton pregnancies and an average of 2.7 was the procedure for each pregnancy. The mean gestation period for each fetus that took part in the study was 28.5 and a standard deviation of (+/-) 4.6 week was considered (Alshimmiri, Hamoud, Al-Saleh, Mujaibel, Al-Harmi, and Thalib, 2003). There was a calculation of inter and intra-observer coefficient. The intra-class coefficient of correlation value was 0.94, and the confidence was 95%, and the interval was 0.93 to 0.95. The interclass shared the same confidence with a variation in the intervals, at between 0.88 to 0.90. The accuracy of the prediction of the severity of anemia in groups for initial cardiocentesis, improved with repeated, with improved middle cerebral artery- peak systolic velocity values before the initial procedures.

Another study was interested in establishing the longitudinal trends of the middle cerebral artery- peak systolic velocity in the fetus who exhibited the moderate or mild hemolytic disease. The study applied a prospective cohort study, which involved 23 fetuses from singleton also immunized pregnancies. The study undertook a serial assessment on the middle cerebral artery- peak systolic velocity. Once the fetus was born, they were grouped based on the need for a postal natal management of the hemolytic disease (Simetka, Petros, Lubusky, Liska, Dolezalkova, Matura, Wiedermannova, and Prochazka, 2014). During the process, a transverse section of the brain, which involved the cavum septi pelludici and the thalamus were identified when the fetus was on rest. With the color of Doppler ultrasound was used to image the circle of Willis. The proximal of the middle cerebral artery- peak systolic velocity transducer was enlarged above 50% of the image to be able to cover its full length.

Similarly, in a different study middle, the cerebral artery was used to assess the neonatal outcome of the alloimmunised pregnancies, which were at a high risk for fetal anemia. The study considered 28 alloimmunized pregnant women who were vulnerable to fetal or neonatal anemia, who had not been through an invasive testing due to the reassuring Doppler measurement. The study however excluded those pregnant women who required an intrauterine transfusion or the usage of invasive methods (Abdel-Fattah, Shefras, Kyle, Cairns, Hunter and Soothill, 2005). The results revealed that avoid the use of invasive methods on pregnant mothers whose fetus were vulnerable to fetal anemia was important. The reliance on the middle cerebral artery Doppler measurement did not contribute to the neonatal or fetal morbidities.

Another study, aimed at comparing the results of amniocentesis and those produced by applying middle cerebral artery- peak systolic velocity, in the quest to detect the anemic fetuses in the Rh alloimmunized pregnancies. The approve for the research was a descriptive study that involved 99 consecutive Rh negative pregnancies. There were 74 alloimmunized patients, who submitted to amniotic fluid spectrophotometry. They were into label group 1, and also 25 cases of alloimmunization were handled by the use of Doppler ultrasonography and were label group2 (Nardozza, Moron, Junior, Camano, Chinen, and Torloni, 2007). The study analyzed two variables which included neonatal hematocrit and the need for neonatal transfusion. The results indicated that the case management through spectrophotometry was associated with the higher need for neonatal transfusion and neonatal hematocrit was significantly lower as compared to when the case management was done using Doppler.

In a different study, a longitudinal study was conducted to reveal the effectiveness of middle cerebral artery- peak systolic velocity, in the prediction of a fetus which will incur a severe case of anemia. The Doppler assessment of the middle cerebral artery- peak systolic velocity was conducted on 15 fetuses which were considered healthy, eight fetuses which were had mild anemia, and 11 fetuses who were deemed to have severe anemia. The three categories were taken through serial measurements at their first cardiocenteses (Detti, Mari, Akiyama, Cosmi, Moise, Stefor, Conaway, and Deter, 2002). Th results indicated that the estimated increase in the average slope increased based on the degree of anemia between the three groups under study. The difference in the mean slope between healthy fetuses and those with mild anemia was not statistically significant. The conclusion was that the middle cerebral artery- peak systolic velocity was a useful tool in predicting the fetuses that are at risk of becoming anemic.

Another study was interested in detecting the rate of fetal anemia by use of ultrasonographic monitoring of those pregnancies which have been complicated by the alloimmunized red blood cells. The study used a prospective approach by monitoring 35 pregnant women maternal red cell alloantibodies for three years (Haugen, Husby, Helbig, and SchmidtMelbye, 2002). The monitoring was conducted through measurements on the fetal peak systolic Doppler flow velocity of the middle cerebral artery and the fetal spleen perimeter. This process was achieved through semi-quantification of the titers of the maternal antibodies, and also through ultrasonographic clinical assessments. The previous obstetric indications revealed that the fetus was at risk of developing mild to moderate anemia.

A different study intended to explore the pregnancy outcome for Rh-alloiumminized women who had been managed through spectrophotometric analysis of the amniotic fluid and middle cerebral artery Doppler ultrasonographical velocimetry. The study was conducted on a descriptive observational study which involved 291consecutive Rh-pregnancies. They were divided into three groups; the first group was composed of 74 isoimmunized women who had been under the spectrophotometric management of the amniotic fluid (Nardozza, Camano, Moron, Silva Pares, Chinen, and Torloni, 2005). The second group was composed of 25 isoimmunized women who were under the management using Doppler ultrasonographical. The third group consisted of 192 nonimmunized women who were Rh-negative (Haugen et al., 2002 and Nardozza et al., 2005). The results indicated that for group one and two the rate for caesarean section, the intrauterine transfusion, and prematurity among other parameters was similar. Neonatal hematocrit was lower, and the need for neonatal transfusion was significantly higher when spectrophotometry was used as compared to the Doppler ultrasonography.

Another study was interested in comparing the effectiveness of the conventional methods for managing red cell alloimminized pregnancies as compared to the middle cerebral artery- peak systolic velocity (Mari et al., 1995 and Nardozza et al., 2005). 29 alloimmunized pregnancies which were affected by the red cell antibodies, were considered in the study. Ten cases management was done my amniocenteses and 19 other through the middle cerebral artery- peak systolic velocity techniques (Sau, El-Matary, Newton, and Wickramarachchi, 2009). The outcome indicated that middle cerebral artery- peak systolic velocity which is the non-invasive method for the monitoring of the alloimmunized pregnancies.

A different study was centered in revealing the accuracy of Doppler ultrasonography in the prediction of the fetal hemoglobin. 18 fetuses were considered in the survey, within the gestation of 19 to 31 weeks. On 15 instances anemia was detected based on the established quadratic relationship between the hemoglobin multiples of the median value and the percentage variations between the observed values and the expected figures (Mari, Detti, Oz, Zimmerman, Duerig, and Stefos, 2002). The study concluded that middle cerebral artery- peak systolic velocity was useful in predicting the vulnerability of a fetus to become anemic based on the values of hemoglobin.

In another study through a systematic, the researchers were interested in establishing a non-invasive mechanism for detecting fetal anemia resulting from the red cell alloimmunization. Eight primary studies which consisted of 362 pregnancies that had been affected by the alloimmunization were involved. The diagnostic test study that applied the best methodology of all the studies revealed a positive likelihood ratio of 8.45 with a confidence interval of 95% and an interval of between 4.69 and 15.56 (Divakaran, Waugh, Clark, Khan, Whittle, and Kilby, 2001). Also, there was a report of a negative likelihood of the ration 0.02 with a 95% confidence at the interval of 0.001 and 0.25 when a maximum middle cerebral artery- peak systolic velocity technique was applied.

In a different study, a new technology for the management of the alloimmunized pregnancies was under consideration. The study was a systematic review of relevant databases such as MEDLINE and Embase with an inclusion of 246 studies. The findings indicated that quantitative polymerase chain reaction could be useful than serology for a more accurate determinatio...