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

ObjectiveTo evaluate whether middle cerebral artery (MCA) peak systolic velocity (PSV) can help to diagnose fetal anemia caused by fetomaternal hemorrhage (FMH).MethodsFifteen 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.ResultsOne 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 22.6 hours and cardiotocography showed a sinusoidal pattern in all cases. Mean time of delivery after MCA-PSV assessment was 48.3 hours 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 3 hours because of acute placental abruption. Kleihauer–Betke testing confirmed FMH, and hemoglobin levels at birth were used to confirm fetal anemia.ConclusionAssessment of MCA-PSV may help to detect signs of fetal anemia in cases of chronic FMH.