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Management of Rh-isoimmunised Pregnancies : Our Experience.
D Arora1, T K Bhattacharyya2, S K Kathpalia3
1Reader, Maternal & Foetal Medicine Specialist, Armed Forces Medical College, Pune - 411040.
Medical Journal, Armed Forces India
|July 14, 2016
Summary
Doppler ultrasound measurement of middle cerebral artery peak systolic velocity (MCA-PSV) effectively detects fetal anemia in Rh- isoimmunized pregnancies. This method guides timely intrauterine transfusions, improving pregnancy outcomes and fetal survival.
Area of Science:
- Maternal-Fetal Medicine
- Diagnostic Ultrasound
- Hematology
Background:
- Rh-isoimmunized pregnancies pose a risk of fetal anemia.
- Accurate detection of fetal anemia is crucial for timely intervention.
- Middle cerebral artery peak systolic velocity (MCA-PSV) is a non-invasive marker for fetal anemia.
Purpose of the Study:
- To evaluate the efficacy of MCA-PSV, measured by Doppler ultrasound, in identifying fetal anemia.
- To assess the role of MCA-PSV in managing Rh-isoimmunized pregnancies.
- To determine the impact of intrauterine fetal blood transfusions guided by MCA-PSV on pregnancy outcomes.
Main Methods:
- Screening of Rh-isoimmunized pregnancies using Doppler ultrasound to measure MCA-PSV.
- Confirmation of fetal anemia via cordocentesis if MCA-PSV exceeded 1.5 MoM.
- Performance of intrauterine fetal blood transfusions for confirmed anemia.
- Evaluation of neonatal outcomes including gestational age at delivery and need for neonatal transfusion.
Main Results:
- Thirteen Rh-isoimmunized pregnancies were assessed.
- Twenty-one intrauterine fetal blood transfusions were performed in ten patients.
- One intrauterine fetal death occurred; other neonates had favorable outcomes.
- Five neonates required transfusion in the postnatal period.
Conclusions:
- Doppler assessment of MCA-PSV is a reliable method for detecting fetal anemia in Rh-isoimmunized pregnancies.
- Intrauterine fetal blood transfusion is vital for prolonging pregnancy and improving survival rates.
- This approach offers a critical intervention for managing high-risk pregnancies.
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