Dopler merenje maksimalnog protoka u sistoli arterije cerebri medije kao dijagnostičko sredstvo u proceni fetalne anemije nakon intrauterine transfuzije kod bolesnica sa Rhesus aloimunizacijom

  • Mirjana Marjanović Cvjetićanin Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
  • Snežana Plešinac Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
  • Jelena Dotlić Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
  • Darko Plećaš Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
  • Dušica Kocijančić Belović Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
  • Slavica Akšam Clinical Center of Serbia, Clinic of Obstetrics and Gynecology, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP180113045M
Ključne reči: fetus, anemija, transfuzija krvi, intrauterina, krvne grupe, nepodudaranje, krvne grupe, rh-hr sistem, ultrasonografija, hematokrit

Sažetak


Uvod/Cilj. Dopler sonografsko merenje maksimalnog protoka tokom sistole u fetalnoj arteriji cerebri mediji (MCA-PSV) može da se koristi u predikciji fetalne anemije kao i za određivanje potrebe za intrauterinom transfuzijom (IUIT) kod bolesnica sa Rhesus (Rh) aloimunizacijom. Cilj studije bio je ispitati da li je merenje MCA-PSV kod fetusa koji su prethodno imali jednu do tri transfuzije dobar dijagnostički pokazatelj za fetalnu anemiju. Metode. Ova prospektivna studija obuhvatila je 36 trudnica koje su ispitivane i lečene zbog Rh aloimunizacije u tercijarnom centru tokom petogodišnjeg perioda (2012–2017). Merili smo MCA-PSV i hematokrit (Hct) kod svih fetusa. Kod sedam trudnica bilo je neophodno primeniti intrauterino transfuzije radi korekcije anemije. Kod ovih bolesnica poredili smo vrednosti MCA-PSV i hematokrita pre i posle svake transfuzije. Rezultati. Hct and MCA-PSV su u negativnoj korelaciji pre terapije in-utero transfuzijom (p = 0,035) i pre i posle druge transfuzije (p = 0,046). Obratno, posle prve (p = 0,954), pre druge (p = 0,738), kao i pre (p = 0,092) i posle (p = 0,741) treće transfuzije nije nađena statistički značajna povezanost između vrednosti Hct i MCA PSV. Vrednosti hematokrita pre i posle transfuzije bile su u pozitivnoj korelaciji (p = 0,001), ali vrednosti MCA PSV nisu (p = 0,296). Prema ROC analizi granični skor za MCA PSV za ispitivane bolesnice bila je 1,22 MoM. Zaključak. Tačnost MCA PSV kao pokazatelja fetalne anemije redukovana je kod fetusa koji su prethodno imali transfuziju. Veće studije su potrebne da bi se objasnili uzroci ove pojave i da bi se potencijalno postavile nove referentne vrednosti MCA-PSV, a u cilju bolje dijagnostike fetalne anemije.

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Objavljeno
2021/08/19
Broj časopisa
Vol. 77 Br. 1 (2020): Vojnosanitetski pregled
Rubrika
Originalni članak