Middle cerebral artery peak systolic velocity in the diagnosis of fetomaternal hemorrhage.

Abstract OBJECTIVE: To evaluate whether middle cerebral artery (MCA) peak systolic velocity (PSV) can help to diagnose fetal anemia caused by fetomaternal hemorrhage (FMH). METHODS: Fifteen women with FMH were included in a longitudinal prospective study. Participants were evaluated via cardiotocography and Doppler assessment of MCA-PSV. Fetomaternal hemorrhage was confirmed via Kleihauer-Betke test, and fetal hemoglobin levels were determined soon after birth. RESULTS: One woman was affected by twin-to-twin transfusion syndrome; FMH was diagnosed with a high MCA-PSV in the recipient fetus, indicating severe anemia. Nine women were referred because of maternal trauma; MCA-PSV values were greater than 1.5 multiples of the median after a mean time of 22.6hours and cardiotocography showed a sinusoidal pattern in all cases. Mean time of delivery after MCA-PSV assessment was 48.3hours because of chronic placental abruption. In the other 5 cases, MCA-PSV was normal, cardiotocography showed a sinusoidal pattern, and delivery occurred in a mean time of 3hours because of acute placental abruption. Kleihauer-Betke testing confirmed FMH, and hemoglobin levels at birth were used to confirm fetal anemia. CONCLUSION: Assessment of MCA-PSV may help to detect signs of fetal anemia in cases of chronic FMH.