New procedure safer for detecting fetal anemia
Non-invasive method better for both mother and fetus
– An innovative, non invasive ultrasound procedure to detect anemia in the fetus during high risk pregnancy is safer for patients, according to a study to be published in the New England Journal of Medicine on Thursday, July 13.
"The research clearly demonstrates that this new procedure, Doppler ultrasonography, provides a safe and non-invasive method to test for fetal anemia which is far less traumatic to the mother and fetus than traditional testing," said Dr. Seaward, who co-led the study and is Director of Labour and Delivery at Mount Sinai Hospital and Associate Professor in the Department of Obstetrics and Gynaecology at the University of Toronto. "We hope more high risk perinatal centres will follow suit and adopt this innovative practice."
Anemia occurs when too few red blood cells are in the bloodstream resulting in insufficient oxygen reaching tissues and organs. It occurs in fetuses that inherit certain types of red blood cell antigens from their fathers that are incompatible with those in their mother. While pregnant, the mother's immune system can create antibodies that attack these conflicting red blood cells in the fetus, which may lead to complications including miscarriage, fetal anemia, fetal heart failure and severe jaundice in the newborn period.
Researchers studied 187 mothers-to-be who had been diagnosed with Rhesus disease, one cause of fetal anemia. This condition allows antibodies to enter the fetus from the mother. Although Rhesus disease is not the only cause of fetal anemia, when mothers have this condition it is more likely that the fetus will develop anemia and therefore it is critical to test these high-risk patients. Those fetuses with severe anemia are treated with fetal blood transfusion while still in the uterus.
Dr. Seaward co-led the study with Dr. Oepkes from Leiden University Medical Centre in the Netherlands, and believes the research will lead to an important and exciting shift in practice whereby physicians will be able to accurately follow fetuses at risk of anemia through the Doppler ultrasonography procedure alone. The test is both effective for mothers who have Rhesus disease, as well as those who are at risk of fetal anemia from alternate causes.
"Traditionally, testing for fetal anemia involved an amniocenteses procedure, where a needle is inserted into the amniotic cavity under ultrasound guidance. This method is highly invasive and uncomfortable for the mother, and carries a risk of miscarriage of the pregnancy, as well as a risk of worsening the fetal anemia. " explains Dr. Seaward. "The Doppler ultrasonography test poses no risk to the fetus as it is simply an ultrasound."
In Canada, approximately one percent of Rhesus negative women have pregnancies at risk of fetal anemia and one out of every 200 mothers tested through amniocenteses miscarry. Doppler ultrasonography allows most at-risk mothers to avoid amniocenteses, and effectively reduces fetal loss due to miscarriage.
The study received a major research award when presented at the Annual Clinical Meeting of the Society for Maternal Fetal Medicine in February 2005.
About Mount Sinai Hospital
Mount Sinai Hospital is recognized nationally and internationally for its excellence in the provision of compassionate care, teaching and research. Its key priority programs are Women's and Infants' Health, surgical Subspecialties and Oncology, Internal Medicine and Subspecialties, and the Samuel Lunenfeld Research Institute. It is a University of Toronto-affiliated patient care, teaching and research centre. Visit www.mtsinai.on.ca
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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