Reference values of fetal middle cerebral artery peak systolic velocity (12-40 weeks of gestation)

Objective: to determine reference values of middle cerebral artery peak systolic velocity in normal fetuses and compare it with the data of fetuses suffering from moderate-severe anemia. Material and methods: fetal middle cerebral artery peak systolic velocity was measured in two groups. The control group (group 1) comprised 530 normal singleton pregnancies and 9 dichorionic twins (total fetal number - 548). There were not any fetal congenital disorders, risk of anemia. All newborns had normal hemoglobin level at birth and good outcomes. The main group (group 2) comprised pregnancies (n = 31) with fetuses suffering from moderate (15/31, 48.4%) or severe (16/31, 51.6%) anemia according to results of fetal blood sampling by cordocentesis. The statistical analysis was performed with the use of RStudio version 1.3.959. Results: fetal middle cerebral artery peak systolic velocity significantly increases with advancing gestation in normal pregnancy and was described by a fifth-degree regression equation (R² = 0.8931, P < 2.2 × 10^-16). Middle cerebral artery peak systolic velocity of anemic fetuses (moderate-severe anemia) were above the line corresponding to the upper limit of 95% confidence interval (for the square root of middle cerebral artery peak systolic velocity). Reference values of fetal middle cerebral artery peak systolic velocity at 12-40 weeks of gestation were presented. ROC-analysis revealed the optimal cut-off value corresponding to the 97.5th percentile with the highest values of the Youden index (0.9708) and AUC (0.9963). Conclusion: the upper limit of 95% confidence interval (97.5th percentile) of fetal middle cerebral artery peak systolic velocity could be recommended as a cut-off value indicating moderate-severe fetal anemia. Future investigations are needed for effectiveness assessment of revealed criteria.

Doppler ultrasound, middle cerebral artery, peak systolic velocity, multiple of the median, fetal anemia, moderate anemia, severe anemia

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