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Middle Cerebral Artery Peak Systolic and Ductus Venosus Velocity Waveforms in the Hydropic Fetus

Prenatal Diagnosis and Fetal Therapy Unit, Department of Gynecological Science and Reproductive Medicine, University of Padua School of Medicine, Padua, Italy (E.C., D.D., A.A., P.L., G.A.); and Department of Obstetrics and Gynecology, University of Sassari School of Medicine, Sassari, Italy (S.D., L.U., G.C.).

Address correspondence and reprint requests to Erich Cosmi, MD, Department of Gynecological Science and Reproductive Medicine, University of Padua, Via Giustiniani 3, 35100 Padua, Italy. E-mail: ecosmi{at}hotmail.com

Objective. The purpose of this study was to assess whether Doppler assessment of the middle cerebral artery (MCA) peak systolic velocity (PSV) and ductus venosus (DV) velocity waveforms during sonography of hydropic fetuses may specify the cause of fetal hydrops. Methods. A level II sonographic examination was performed in 16 hydropic fetuses, and the MCA PSV and DV velocity waveforms were assessed. The MCA PSV values divided hydropic fetuses into anemic (group 1) and nonanemic (group 2) fetuses. In group 2 fetuses, the DV was defined as normal or abnormal. Sonographic examination and Doppler assessment of these vessels specified the cause of hydrops and indicated the use of specific investigations for diagnosing the etiology of fetal hydrops. Results. Seven of 16 fetuses had MCA PSV values greater than 1.50 multiples of the median (group 1). Nine of 16 fetuses had normal MCA PSV values (group 2); among them, 7 of 9 had either absent or reversed flow in the DV, and 2 had a normal DV. In group 1, the cause of fetal anemia was investigated by maternal serum tests, and 5 cordocentesis procedures were performed. In group 2, 7 of 9 fetuses had reversed flow in the DV, which suggested a cardiac abnormality confirmed by echocardiography. Five cordocentesis procedures were performed for fetal karyotype, and in 2 fetuses, the cause of hydrops was idiopathic. Conclusions. Our data suggest that assessment of the MCA PSV and DV velocity waveforms in the hydropic fetus may further our knowledge of the etiology of hydrops and may indicate which investigations among the many available should be used for diagnosing the cause of fetal hydrops.

Key Words: Doppler sonography • ductus venosus • fetal anemia • fetus • hydrops • middle cerebral artery • nonimmune fetal hydrops • peak systolic velocity

Abbreviations: CHD, cardiac heart defect • DV, ductus venosus • MCA, middle cerebral artery • MoM, multiples of the median • PSV, peak systolic velocity

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