Intrauterine transfusion (IUT) has changed fetal anemia prognosis. However, long-term neurodevelopmental outcome is altered in 5% of children. Our objective was to study the contribution of fetal MRI to diagnosis brain lesions in case of fetal anemia.
Material and Methods: Retrospective monocentric descriptive study from 2005 to 2016, including all patients followed for fetal anemia requiring IUT. The indications for MRI were: hydrops fetalis and / or hemoglobin <5 g / dL and / or more than 3 IUTs and / or acute severe anemia and / or ultrasound abnormality. Fetal and neonatal outcome and pediatric neurological monitoring were studied.
89 patients were followed for fetal anemia with IUT and 28 (29.1%) had fetal MRI, 12 of which were abnormal. Two out of twelve had abnormal ultrasound. Seven out of twelve had poor neurological prognosis: 2 medical terminations of pregnancy were performed; 2 children had severe developmental delay and 3 children had schooling difficulties. Five out of twelve children had favorable neurological prognosis.
MRI of the fetal brain makes it possible to better detect brain lesions than ultrasound does in the management of severe fetal anemia and seems particularly appropriate in cases of acute anemia.
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- Allo-immunisation fœtomaternelle érythrocytaire.EMC - Obstétrique. 2009; 4: 1-7
- Thérapies fœtales: anémie fœtale et transfusion in utero.Lett Gynécologue. 2011; 367: 20-24
- Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization.Am J Obstet Gynecol. 2005; 192: 171-177
- In utero treatment of severe fetal anemia resulting from fetomaternal red blood cell incompatibility: a comparison of simple transfusion and exchange transfusion.Eur J Obstet Gynecol Reprod Biol. 2016; 201: 85-88
- Is intrauterine exchange transfusion a safe procedure for management of fetal anaemia?.Eur J Obstet Gynecol Reprod Biol. 2014; 179: 83-87
- Long-term neurodevelopmental outcome and brain volume after treatment for hydrops fetalis by in utero intravascular transfusion.Am J Obstet Gynecol. 2006; 195: 192-200
- Treatment of fetal erythroblastosis by intravascular transfusions: outcome at 6 years.Obstet Gynecol. 1999; 93: 165-168
- Outcome for children treated with fetal intravascular transfusions because of severe blood group antagonism.J Pediatr. 1997; 131: 373-380
- Long-term neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn: the LOTUS study.Am J Obstet Gynecol. 2012; 206: 141.e1-141.e8
- Fetal cerebellar damage in fetuses with severe anemia undergoing intrauterine transfusions.J Matern Fetal Neonatal Med. 2016; 29: 389-392
- Brain ultrasound findings in neonates treated with intrauterine transfusion for fetal anaemia.Early Hum Dev. 2012; 88: 717-724
- Feasibility and reproducibility of diffusion-weighted magnetic resonance imaging of the fetal brain in twin-twin transfusion syndrome.Prenat Diagn. 2014; 34: 1182-1188
- Fetal brain injury in survivors of twin pregnancies complicated by demise of one twin as assessed by in utero MR imaging.Prenat Diagn. 2015; 35: 583-591
- Fetal magnetic resonance imaging (MRI) of ischemic brain injury.Prenat Diagn. 2001; 21: 729-736
- Use of MRI in the diagnosis of fetal brain abnormalities in utero (MERIDIAN): a multicentre, prospective cohort study.Lancet Lond Engl. 2017; 389: 538-546
- Noninvasive diagnosis by doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses.New Engl J Med. 2000; 342: 9-14
- ISUOG practice guidelines: use of doppler ultrasonography in obstetrics.Ultrasound Obstet Gynecol. 2013; 41: 233-239
- Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia–diagnosis and management.Am J Obstet Gynecol. 2015; 212: 697-710
- Two hundred intrauterine exchange transfusions in severe blood incompatibilities.Am J Obstet Gynecol. 1989; 161: 709-713
- Neonatal outcome after fetal anemia managed by intrauterine transfusion.Eur J Pediatr. 2015;
- Intraventricular hemorrhage and brain injury in the premature infant. Diagnosis, prognosis, and prevention.Clin Perinatol. 1989; 16: 387-411
- Correlation between the degree of periventricular leukomalacia diagnosed using cranial ultrasound and MRI later in infancy in children with cerebral palsy.Neuropediatrics. 1993; 24: 263-268
- Prenatal diagnosis of anoxic cerebral lesions caused by profound fetal anemia secondary to maternal red blood cell alloimmunization.Obstet Gynecol. 2008; 112: 442-444
- Sonographic demonstration of brain injury in fetuses with severe red blood cell alloimmunization undergoing intrauterine transfusions.Ultrasound Obstet Gynecol. 2004; 23: 428-431
- Value of prenatal ultrasound and magnetic resonance imaging in assessment of congenital primary cytomegalovirus infection.Ultrasound Obstet Gynecol. 2010; 36: 709-717
- Early detection by diffusion-weighted sequence magnetic resonance imaging of severe brain lesions after fetoscopic laser coagulation for twin-twin transfusion syndrome.Ultrasound Obstet Gynecol. 2014; 44: 44-49
Published online: June 06, 2018
Accepted: May 31, 2018
Received in revised form: April 10, 2018
Received: October 22, 2017
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