The Journal of reproductive medicine · 1997
Ultrasonographic fetal cardiac measurement in isoimmunized pregnancies.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Ouzounian J G, Monteiro H A, Alsulyman O M, Songster G S
Аннотация
OBJECTIVE: To investigate the predictive value of the ultrasonographically measured fetal biventricular outer dimension (BVOD) in diastole in detecting neonatal anemia in pregnancies complicated by isoimmunization.
STUDY DESIGN: The records of all patients evaluated for isoimmunization in pregnancy from January 1992 to December 1994 were reviewed retrospectively. The fetal BVOD had been measured with real-time-directed M-mode fetal echocardiography. The BVOD measurement was plotted on a nomogram (with reference to biparietal diameter) and a percentile value determined graphically from the nomogram. Neonatal outcome was obtained prospectively and by chart review.
RESULTS: Sixty-three singleton fetuses from the study period who met entry criteria were identified. Anti-D sensitization represented 66% of cases of isoimmunization. Twenty (32%) fetuses required subsequent neonatal transfusion, and 43 (68%) did not. Seventeen fetuses (27%) had BVOD measurements greater than the 95th percentile, and 10 (59%) required subsequent transfusion. Infants in this group also had significantly lower hematocrits at birth (37.7 +/- 13.0% vs. 46.6 +/- 9.0%) and prolonged neonatal intensive care unit stay (10.7 +/- 10.0 vs. 4.7 +/- 3.6 days), respectively, when compared to patients with a BVOD measurement less than the 95th percentile. A BVOD 95th percentile threshold had a sensitivity, specificity and positive predictive value of 50%, 84% and 59%, respectively, in predicting the need for neonatal transfusion.
CONCLUSION: In patients with isoimmunization, a BVOD measurement in the 95th percentile or greater was associated with a relatively high likelihood of neonatal anemia and transfusion. Although the measurement is not sufficiently sensitive to be used as a single parameter in predicting neonatal compromise in these patients, it can be a useful, noninvasive adjunct to the management of isoimmunized pregnancies.
STUDY DESIGN: The records of all patients evaluated for isoimmunization in pregnancy from January 1992 to December 1994 were reviewed retrospectively. The fetal BVOD had been measured with real-time-directed M-mode fetal echocardiography. The BVOD measurement was plotted on a nomogram (with reference to biparietal diameter) and a percentile value determined graphically from the nomogram. Neonatal outcome was obtained prospectively and by chart review.
RESULTS: Sixty-three singleton fetuses from the study period who met entry criteria were identified. Anti-D sensitization represented 66% of cases of isoimmunization. Twenty (32%) fetuses required subsequent neonatal transfusion, and 43 (68%) did not. Seventeen fetuses (27%) had BVOD measurements greater than the 95th percentile, and 10 (59%) required subsequent transfusion. Infants in this group also had significantly lower hematocrits at birth (37.7 +/- 13.0% vs. 46.6 +/- 9.0%) and prolonged neonatal intensive care unit stay (10.7 +/- 10.0 vs. 4.7 +/- 3.6 days), respectively, when compared to patients with a BVOD measurement less than the 95th percentile. A BVOD 95th percentile threshold had a sensitivity, specificity and positive predictive value of 50%, 84% and 59%, respectively, in predicting the need for neonatal transfusion.
CONCLUSION: In patients with isoimmunization, a BVOD measurement in the 95th percentile or greater was associated with a relatively high likelihood of neonatal anemia and transfusion. Although the measurement is not sufficiently sensitive to be used as a single parameter in predicting neonatal compromise in these patients, it can be a useful, noninvasive adjunct to the management of isoimmunized pregnancies.