Case reports

Limitations of middle cerebral artery peak systolic velocity in the detection of severe anaemia: A case report

L Geerts, J N Rossouw, A C van Wyk, C A Wright

Abstract


Doppler examination of the fetal middle cerebral artery (MCA) is considered highly reliable in detecting severe fetal anaemia. We present a case of a mother with severe pre-eclampsia at 32 weeks’ gestation and non-immune fetal hydrops without obvious cause. Since the MCA peak systolic velocity (PSV) was normal, severe anaemia was not considered as a possible cause, but after delivery the infant was found to be severely anaemic and died. Histological examination of the placenta revealed multiple extensive haemorrhages (subchorionic, intraparenchymal and intravillous), and autopsy indicated that the most likely cause of death was severe anaemia and hypoxia due to multiple and extensive placental haemorrhages, which had developed over the course of several days. We postulate that the MCA PSV failed to indicate severe anaemia because of the combination of subacute anaemia with severe profound hypoxia due to placental insufficiency.


Authors' affiliations

L Geerts, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

J N Rossouw, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

A C van Wyk, Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa

C A Wright, Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa; National Health Laboratory Service, Port Elizabeth, South Africa

Full Text

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Keywords

Fetal anaemia; Doppler ultrasound, Hydrops

Cite this article

South African Journal of Obstetrics and Gynaecology 2015;21(2):44-45. DOI:10.7196/sajog.898

Article History

Date submitted: 2014-07-02
Date published: 2015-12-14

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