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Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta-analysis.
- Source :
-
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2019 Dec; Vol. 54 (6), pp. 722-731. - Publication Year :
- 2019
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Abstract
- Objective: To evaluate the performance of fetal middle cerebral artery peak systolic velocity (MCA-PSV) ≥ 1.5 multiples of the median (MoM) for the prediction of moderate-severe anemia, in untransfused and transfused fetuses.<br />Methods: A systematic search was performed to identify relevant observational studies reported in the period 2008-2018 that evaluated the performance of MCA-PSV, using a threshold of 1.5 MoM for the prediction of fetal anemia. Diagnosis of fetal anemia by blood sampling was the reference standard. A hierarchical summary receiver-operating characteristics (hSROC) curve was constructed using random-effects modeling. Subgroup and meta-regression analyses, according to the number of previous intrauterine transfusions, were performed.<br />Results: Twelve studies and 696 fetuses were included in the meta-analysis. The area under the hSROC curve (AUC) for moderate-severe anemia was 83%. Pooled sensitivity and specificity (95% CI) were 79% (70-86%) and 73% (62-82%), respectively, and positive and negative likelihood ratios were 2.94 (95% CI, 2.13-4.00) and 0.272 (95% CI, 0.188-0.371). When considering only untransfused fetuses, prediction improved, achieving an AUC of 87%, sensitivity of 86% (95% CI, 75-93%) and specificity of 71% (95% CI, 49-87%). A decline in sensitivity for the prediction of moderate-severe anemia by MCA-PSV ≥1.5 MoM was observed (estimate, -5.5% (95% CI, -10.7 to -0.3%), P = 0.039) as the number of previous transfusions increased.<br />Conclusions: MCA-PSV ≥ 1.5 MoM for the prediction of moderate-severe anemia in untransfused fetuses shows moderate accuracy (86% sensitivity and 71% specificity), which declines with increasing number of intrauterine transfusions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.<br /> (Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.)
- Subjects :
- Anemia blood
Blood Transfusion, Intrauterine adverse effects
Blood Transfusion, Intrauterine mortality
Female
Fetal Diseases diagnostic imaging
Fetal Diseases physiopathology
Fetus blood supply
Fetus physiopathology
Gestational Age
Humans
Middle Cerebral Artery physiopathology
Observational Studies as Topic
Predictive Value of Tests
Pregnancy
Sensitivity and Specificity
Severity of Illness Index
Anemia diagnosis
Blood Flow Velocity physiology
Middle Cerebral Artery diagnostic imaging
Ultrasonography, Doppler, Color methods
Subjects
Details
- Language :
- English
- ISSN :
- 1469-0705
- Volume :
- 54
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 30932276
- Full Text :
- https://doi.org/10.1002/uog.20273