Journal of Clinical and Diagnostic Research. 2012 May (Suppl-2), Vol-6(4): 688-691 688 688 ID: JCDR/2012/3411.3964:0035 Original Article An Indian Study of a Novel Non-invasive Method of Screening for Foetal Anaemia Key Words: Foetal Anaemia, Middle cerebral artery, Non-invasive test, Color Doppler Ultrasound, KG Waveform, Pravara Effect, Mind ABSTRACT Purpose: The assessment of foetal Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) is useful in non-invasively diagnosing foetal anaemias, irrespective of their cause. A study was therefore undertaken to find out its effectiveness in the local obstetric population. Materials and methods: Doppler ultrasound measurements of foetal MCA-PSV were done in 1200 pregnant women who were referred for antenatal ultrasound between 12-40 weeks of gestation. The statistical analysis was done by using Microsoft Excel 2007 and SPSS software, version 12. Results: A statistically significant (p < 0.05) positive correlation was found to exist between the gestational age and MCA-PSV. 14 foetuses had their MCA-PSV elevated enough to label them as being anaemic. Iso-immunization was seen in 4 foetuses, severe maternal hypertension in 4, foetal parvo virus B19 infection in 3 and thalassemia in 3. Also, a disturbed MCA waveform pattern (The K-G waveform) was transiently seen in few cases with normal MCA-PSV values (The Pravara Effect). Conclusion: Foetal MCA-PSV can objectively demonstrate foetal anaemia in pregnant patients, irrespective of the underlying cause. Every effort must therefore be made to use this non-invasive test to look for foetal anaemia in the obstetric population. SUSHIL. G. KACHEWAR, SIDDAPPA.G. GANDAGE, HEMANT. J. PAWAR INTRODUCTION The accurate figures of foetal anaemia are scarce throughout the world, as those who are afflicted are often unreported, undiagnosed and even unsuspected. It is possible that many unexplained intra- uterine deaths may in fact be due to the yet undiagnosed foetal anaemia. The inadequate knowledge about the availability of a rapid and effective non invasive diagnostic test also plays a vital role in this grim scenario. Until recently, everyone relied on invasive measures like cordocentesis to obtain foetal blood and amniocentesis to obtain liquor for spectrophotometry, to assess the presence of foetal anaemia. But, the mounting evidence that the elevated values of foetal Middle Cerebral Artery Peak Systolic Velocities (MCA- PSV) can indicate foetal anaemia has ushered in a new angle to the entire perspective on foetal anaemia. This test soon became popular due to its non-invasive nature and it is now being routinely used for the non-invasive assessment and the follow up of foetal anaemias [1-4]. As very few studies have been reported [1,5] on this topic from the developing world, we undertook a prospective, cross sectional study on foetal MCA-PSV to evaluate its utility in the local community and also to validate whether the value of the foetal MCA-PSV increased with the advances in pregnancy, as had been reported earlier, [1- 6]. MATERIALS AND METHODS After prior approval from the institutional ethical and research committees, this study was carried out in the ultrasound section. An informed written consent was obtained from each participant. Radiology Section 1200 women who had singleton pregnancies with a gestational age between 12 to 40 weeks were randomly selected for the study. The foetal MCA-PSV was recorded by a single observer who had more than ten years of experience in ultrasound, by using a Siemens G-60 Doppler ultrasound machine. With the patient lying supine and at ease on the bed, a transverse section of the foetal head was obtained on the B mode imaging by using a 3.5 MHz curvilinear transducer. The colour mode was then switched on and the foetal MCA was localized near the circle of Willis. After the visualization of the entire length of the MCA, a pulse Doppler was used to sample it just after its origin from the internal carotid arteries, while the angle of insonation was kept at nearly zero degrees. After obtaining a steady waveform, the image was freezed and the peak of the systolic velocity was measured [Table/Fig 1]. The entire process took around 5-15 minutes. The data was compiled and statistically analyzed by using Microsoft Excel 2007 and SPSS software, version 12. The correlation between MCA-PSV and the gestational age was assessed by using the Karl Pearson`s Correlation Coefficient (r) and the ‘t’-test as a test of significance. The MCA-PSV values were compared with the standard published international values to evaluate whether foetal anaemia was present or not. RESULTS The scatter diagram [Table/Fig 2] shows the correlation between the gestational age of the foetus and its MCA-PSV. As shown by the upward slope of the line, a positive correlation was found to