the effect of fetal intrauterine blood transfusion on ductal arterial blood flow velocity and cardiac output changes in fetuses with rhesus alloimmunization-related anemia

Background: echocardiographic indicators may be useful as an alternative method to determine the appropriate time for intervention, especially when doppler assessment of the middle cerebral artery peak systolic velocity (mca-psv) is inconclusive. in this study, arterial duct blood flow and cardiac output of fetuses with rh alloimmunization-related anemia were compared before and after intrauterine transfusion (iut). methods: fifty intrauterine blood transfusions were performed on anemic fetuses in this study. all cases were attributed to rh alloimmunization, detected with mca-psv doppler ultrasound imaging assessments. they all underwent intrauterine blood transfusion and echocardiographic assessments a day before and 24 hr after the procedure. the measured cardiac indices included the velocity time integral (vti) of the aortic and pulmonary valves, the ductus arteriosus acceleration-to-ejection time (at/et) ratio, and the mca-psv. analyses were performed in spss v24 (p<0.05) using paired t-tests for mean differences and pearson's correlation for associations between continuous variables. results: aortic and pulmonary valve vti, mca-psv, and ductus arteriosus at/et ratio significantly decreased after intrauterine blood transfusion (p<0.001). the aortic valve vti and ductus arteriosus accurately detected anemia, with areas under the receiver operating characteristic (roc) curve of 99.9% and 98.9%, respectively. conclusion: all the measured parameters showed significant changes after intrauterine blood transfusion. aortic valve vti and ductus arteriosus at/et ratio seem to have the highest accuracy in detecting anemia. echocardiographic assessment can be beneficial in defining the appropriate time for intrauterine blood transfusion in cases where mca-psv is inefficient.