Measuring MCA-PSV of Foetuses Using Doppler Technique to Detect Foetal Anaemia

The establishing of the foetal anaemia in the pregnancies that had been complicated by the blood group immunization from the maternal side, was done though the Doppler measurements. The study assessed 158 foetuses, where 135 exhibited a standard value for middle cerebral artery-peak systolic velocity and 23 foetuses who showed a risk of becoming anaemic. 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 foetal biometry was used to determine the age of the foetus 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 foetuses who were scheduled for 56 cardiocenteses (Mari, et al., 1995). Group C had 16 foetuses planned for 42 cardiocenteses, who were also vulnerable to foetal anaemia. The receiver operating characteristic was used to determine the cut-off point that was utilized in distinguishing between the foetus which suffered from anaemia and those that did not have anaemia issues, in the group B by the application of the middle cerebral artery-peak systolic velocity. Data from group A was used to device a test for establishing foetal anaemia 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 foetal anaemia for group C participants. A different study was centered in revealing the accuracy of Doppler ultrasonography in the prediction of the foetal hemoglobin. 18 foetuses were considered in the survey, within the gestation of 19 to 31 weeks. On 15 instances anaemia 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 et al., 2002). The study concluded that middle cerebral artery-peak systolic velocity was useful in predicting the vulnerability of a foetus to become anaemic based on the values of hemoglobin.

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In a different study, middle cerebral artery-peak systolic velocity was considered as a non-invasive method to assess the severity of foetal anaemia. The invasive methods such as amniocentesis, are associated with various complications such as foetal bleeding and rupture of the membrane and subsequent loss of the foetus 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 foetuss middle cerebral artery, to have a correlation with the severity of anaemia. The study was carried out by sampling the blood of 66 foetuses and performed on 20 singleton pregnancies and an average of 2.7 was the procedure for each pregnancy. The mean gestation period for each foetus that took part in the study was 28.5 and a standard deviation of (+/-) 4.6 week was considered (Alshimmiri et al., 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 anaemia in groups for initial cardiocentesis, improved with repeated, with improved middle cerebral artery-peak systolic velocity values before the initial procedures.

The prediction of the foetal anaemia by the middle cerebral artery-peak systolic velocity in the pregnancies that were complicated by rhesus isoimmunization, was considered under the idea, that the measure of the levels of hemoglobin varied at different gestation period, as determined through the measure of media technique (Alshimmiri et al., 2003). The standard diagnostic reference was the concentration of the hemoglobin from the blood samples collected from the foetus. The hemoglobin concentration of between 0.84 and 0.65 was considered moderate. Hemoglobin concentration of less than 0.55 was considered severe anaemia.

The Doppler evaluations of the middle cerebral artery- peak systolic velocity is a significant tool in the quantifying the concentration of hemoglobin (Mari et al., 2002). This is valuable in helping to predict the foetal anaemia in pregnancies that has been complicated by red cell alloimmunization.

USING LONGITUDINAL TRENDS OF MCA-PSV TO PREDICT FOETAL ANAEMIA

The longitudinal trends of the middle cerebral artery-peak systolic velocity in the foetus who exhibited the moderate or mild hemolytic disease were reviewed by a study. The study applied a prospective cohort study, which involved 23 foetuses from singleton also immunized pregnancies. The study undertook a serial assessment on the middle cerebral artery-peak systolic velocity. Once the foetus was born, they were grouped based on the need for a postal natal management of the hemolytic disease (Simetka et al., 2014). During the process, a transverse section of the brain, which involved the cavum septi pelludici and the thalamus were identified when the foetus 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, a longitudinal study was conducted to reveal the effectiveness of middle cerebral artery-peak systolic velocity, in the prediction of a foetus which will incur a severe case of anaemia. The Doppler assessment of the middle cerebral artery-peak systolic velocity was conducted on 15 foetuses which were considered healthy, eight foetuses which were had mild anaemia, and 11 foetuses who were deemed to have severe anaemia. The three categories were taken through serial measurements at their first cardiocenteses (Detti et al., 2002). The results indicated that the estimated increase in the average slope increased based on the degree of anaemia between the three groups under study. The difference in the mean slope between healthy foetuses and those with mild anaemia was not statistically significant. The conclusion was that the middle cerebral artery-peak systolic velocity was a useful tool in predicting the foetuses that are at risk of becoming anaemic.

Middle cerebral artery-peak systolic velocity accuracy in diagnosing foetal anaemia increases with an increase in the severity of the anaemia (Detti et al., 2002). Intrauterine transfusion leads to a change in the blood characteristics which also affects the correlation between hemoglobin values and middle cerebral artery- peak systolic velocity. Despite the correlation between spleen perimeter and hemoglobin value, this is a not predict of the foetal anaemia (Haugen et al., 2002). As compared to the middle cerebral artery-peak systolic velocity technique.

THE USE OF NON-INVASIVE METHODS TO REASSURE PREGNANCIES AT RISK OF FOETAL ANAEMIA

A study on middle cerebral artery was used to assess the neonatal outcome of the alloimmunised pregnancies, which were at a high risk for foetal anaemia. The study considered 28 alloimmunized pregnant women who were vulnerable to foetal or neonatal anaemia, 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 et al., 2005). The results revealed that avoid the use of invasive methods on pregnant mothers whose foetus were vulnerable to foetal anaemia was important. The reliance on the middle cerebral artery Doppler measurement did not contribute to the neonatal or foetal morbidities.

Avoiding the intrauterine invasive procedures and subsequently depending on middle cerebral artery Doppler velocity reduces the chances of neonates and foetus life-threatening morbidities (Abdel-Fattah et al., 20015 and Nardozza et al., 2005). The foetus that had been handled through Doppler ultrasonography recorded a higher neonatal hematocrit as well as a lower rate of neonatal transfusion, as compared to those under the amniotic fluid study (Nardozza et al., 2007 and Nardozza et al., 2005). The problem with AFS is due to the material and foetal risks such as infection and foetal injuries associated with amniocentesis. Also in the presence of meconium, it may lead a falsified elevation of the values showing the degree of anaemia.

THE EFFECTIVENESS OF AMNIOCENTESIS AND MCA-PSV IN DETECTING FOETAL ANAEMIA

In a study by Nardozza et al. (2007), the results when amniocentesis and the middle cerebral artery-peak systolic velocity, were applied to detect anaemic foetuses in the Rh alloimmunized pregnancies were compared. The approach of 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. 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.

Similarly, 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 et al., 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.

THE EFFICIENCY OF ULTRASO...