Fetal middle cerebral artery peak systolic velocity and cardiothoracic ratio in fetal anemia diagnosis

Objective: to determine the value of using cardiothoracic ratio (CTR) as a second criterion, along with the peak systolic velocity in the middle cerebral artery (PSV-MCA) for a more accurate diagnosis of moderate-severe fetal anemia. Material and methods: fetal CTR was measured in two groups of pregnant women with normal pregnancy (group 1, n = 368) and anemic fetuses (group 2, n = 20). These groups made up a training sample. To test the diagnostic algorithm, a comparison group was formed (group 3, n = 61). The results were analyzed by the scikit-learn Machine learning in Python. Results: CTR increases with gestation and differs in groups of normal fetuses (group 1) and moderate-severe anemic fetuses (group 2) (P < 0.01). A logistic regression analysis was performed, a discriminant function was obtained, and a model was constructed. That allows the selection of fetuses with mode rate-severe anemia with an error value of 0,5%. For the diagnosis of moderate-severe fetal anemia, it is necessary to evaluate the PSV-MCA, and if the upper boundary of the 95% confidence interval is exceeded, to evaluate the CTR (two criteria). A comparative ROC analysis of the author’s approach and the G. Mary’s et al. (2000) approach (one criterion - PSV-MCA) was carried out. For the analysis, a test sample (group 3) was used, which did not participate in the evaluation of the model. The author’s approach is characterized by sensitivity 93.3%, specificity 100.0%, positive predictive value 100.0%, negative predictive value 97.9%, false positive fraction 0.0%, false negative fraction 6.7%, AUC (area under the curve) 0.966; the G. Mary’s et al. (2000) approach - 100.0%, 84.8%, 68.2%, 100.0%, 15.2%, 0.0%, 0.920, accordingly. Conclusion: the proposed diagnostic method of moderate-severe fetal anemia with a low level of false positive results makes it possible to avoid unjustified interventions, which is especially important in early pregnancy due to high risk of complications.

Doppler ultrasound, middle cerebral artery, peak systolic velocity, multiple of median, fetal anemia, moderate anemia, severe anemia, cardiothoracic ratio, hemolytic disease

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