The Literature Review of Studies: Effectiveness of MCA-PSV on the Detection and the Diagnosis of the Fetal Anemia

The literature review focused on various studies based on the application and effectiveness of middle cerebral artery- peak systolic velocity MCA-PSV on the detection and the diagnosis of the fetal anemia. It also considered studies that applied non-invasive techniques in handling pregnancies of alloimmunized women. It also focused on reviewing literature that exposed the longitudinal trends of MCA-PSV to predict fetus anemia. The effectiveness of amniocentesis and MCA-PSV in detecting fetal anemia, was also taken under consideration. The efficiency of ultrasonographic monitoring of pregnancies associated with cell alloimmunization in the detection of fetus anemia and the outcome of such pregnancies, was part of what was reviewed. And finally, the new technology in the management of red cell alloimmunization pregnancies was studied.

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Measuring MCA-PSV of fetuses using Doppler technique to detect fetus anemia

The establishing of the fetal anemia 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 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. 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 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.

The prediction of the fetal anemia 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 fetus. The hemoglobin concentration of between 0.84 and 0.65 was considered moderate. Hemoglobin concentration of less than 0.55 was considered severe anemia.

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 fetal anemia in pregnancies that has been complicated by red cell alloimmunization.

Using longitudinal trends of MCA-PSV to predict fetus anemia

The longitudinal trends of the middle cerebral artery- peak systolic velocity in the fetus who exhibited the moderate or mild hemolytic disease were reviewed by a study. 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, 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). The 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.

Middle cerebral artery- peak systolic velocity accuracy in diagnosing fetal anemia increases with an increase in the severity of the anemia (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 fetal anemia (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 fetal anemia

A study on middle 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.

Avoiding the intrauterine invasive procedures and subsequently depending on middle cerebral artery Doppler velocity reduces the chances of neonates and fetus life-threatening morbidities (Abdel-Fattah et al., 20015 and Nardozza et al., 2005). The fetus 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 fetal risks such as infection and fetal injuries associated with amniocentesis. Also in the presence of meconium, it may lead a falsified elevation of the values showing the degree of anemia.

The effectiveness of amniocentesis and MCA-PSV in detecting fetal anemia

A 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.

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, 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 a...