Diagnosis and Treatment of Fetal Anemia: Eight Years Experience of a Tertiary Center

Abstract

Introduction

This study aimed to evaluate the efficacy of middle cerebral artery peak systolic velocity measurement in predicting moderate-to-severe fetal anemia and assess perinatal outcomes in patients who underwent intrauterine transfusion for fetal anemia.

Patients and Methods

A retrospective cohort of 91 pregnant women at risk of fetal anemia, delivered between 2016 and 2024, was studied. The efficacy of middle cerebral artery peak systolic velocity in predicting moderate-severe fetal anemia was assessed. Additionally, the perinatal outcomes of fetuses undergoing intrauterine transfusion were analyzed.

Results

The middle cerebral artery peak systolic velocity threshold of 1.5 multiples of the median demonstrated a sensitivity of 92.3% and a specificity of 85.7% in predicting moderate-to-severe fetal anemia before the 35th gestational week. After the 35th gestational week, sensitivity and specificity were 73.3% and 79.1%, respectively. A total of 53 intrauterine transfusion procedures were conducted on 24 patients. The survival rate among fetuses appropriately treated with intrauterine transfusion (n=22) was 68.2%, and the complication rate per procedure was 11.3%. All intrauterine and neonatal deaths (n=9) occurred in hydropic fetuses. All neonates who had undergone intrauterine transfusion were admitted to the neonatal intensive care unit for advanced care.

Conclusions

Middle cerebral artery Doppler is a valuable method for the screening and monitoring of fetal anemia, particularly before the 35th gestational week. Intrauterine transfusion should be considered the preferred treatment for moderate-to-severe fetal anemia. Given the potential risks and complications associated with intrauterine transfusion, hydropic fetuses appear to be at an elevated risk.

Keywords

doppler ultrasound - fetal anemia - middle cerebral artery - intrauterine transfusion

Publication History

Received: 27 December 2024

Accepted after revision: 14 March 2025

Article published online:
10 April 2025

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