Mother : Definition
& Qualification of a mother?? Ans:
In the vast world it is the own mother who first realizes that her son/daughter
is unwell, irrespective of their age . Mother understands this even her son/
daughter is thousand Km away from her by listening to voice /video call. Even if her sibling is at UK/US and I have no hesitation
that irrespective of sibling’s age. The voice of her son/ daughter sends
signals which can be picked up by mother earliest. I repeat earliest. This is
untrue in case of MCA Doppler but possibly true in case Umb A Doppler.
Q.1:-How best we
can utilize “Middle Cerebral Artery”..Ans:-MCA offers us
some signals which we the Obstretricins must be ready to interpretof such warning ringing bail---something is wrong in foetus.
Doppler Velocimetry
interrogation of the
middle cerebral artery has received particular
attention because of observation
that the hypoxic fetus attempts brain
sparing by reducing cerebrovascular impedance , cerebral A dilatation , more blood flow to cerebrum due
to systemic anoxia and thus increasing blood flow to such a vital organ like brain.
Such brain sparing
in growth restricted fetuses has been reflected
by USG to undergo reversal of PSV in MCA
in the sense of more diast flow in MCA as anoxaemia progresses due to placental
insuffinecy . Many a investigators
have reported that about 50% of such fetuses with
this kind of reversal died if such an important finding is ignored .
Q.2:-:-Which one is a better method to pick up foetal anoxaemia?
Modified BPP or MCA Doppler??? Ans:- With graet curiosity ,
the researchers have
curiously randomized women undergoing a) modified
biophysical profile
evaluation b) MCA
Doppler or c) combined
with middle cerebral and umbilical artery
velocity flow assessment . There were no significant differences in pregnancy outcomes between all these three study groups.
Q. 3:-What is Peak Systolic Velocity (PSV) ? Ans:-It
is the threshold values >1.5
multiples of the median for given
gestational ages correctly
identified all fetuses with
moderate or severe anemia.
This provided a sensitivity of
100 percent with a false positive rate of
12 percent.
Q. 4:Cut off punt?
Warning bell –at what point of time? What PSV findings will tell is by carrying out for more frequent MCA
Doppler follow up?? Ans:-The MCA
peak systolic velocity is to be followed serially and values are plotted
on a curve. If the velocity is between 1.0
and 1.5 MoM and the slope is increasing -
such that the value is
approaching 1.5 MoM – surveillance is
generally increased to weekly Doppler interrogation.
Q. 5:-Comparing serial “amniocentesis
for measurement of bilirubin levels” with “Serial Doppler
measurement in MCA ?? Ans:-Researchers have
in last three decades confidently used middle
cerebral artery Doppler Velocimetry in eiu of Liley curve of quantifying
bilirubin in A fluid to detect
severe fetal anemia in fetuses with D
alloimmunization ??
Ans:-.
They prospectively compared serial
amniocentesis for measurement of bilirubin levels with Doppler measurement of peak systolic velocity in the middle cerebral artery. These investigator concluded that Doppler could safely
replace amniocentesis in the management
of allo immunized pregnancies. Remind you my dear members that middle
cerebral artery Doppler Velocimetry is useful for detection and management of fetal anemia of any etiology . The American College of
Obstetricians and
Gynecologists also concluded that
such use of Doppler is appropriate
in centers with personnel trained in the procedure.
Q.6:
When to proceed for Cordocentesis to estimate foetal anemia directly??
Ans:-If the MCA peak systolic
velocity exceeds 1.5 MoM , and if one
intends to continue the indexed pregancy then only further evaluation by fetal blood sampling is necessary . This
complex invasive procedure is carried out to assess need for fetal transfusion. The false positive rate increases
significantly beyond 35 weeks due to the normal increase in cardiac
output that develops at this
gestational age Q.7:-At prsent time is there
any indication of Cordocentesis to diagnose foetal anemia with certainty in cases of Rh iso immunization?? How best to
diagnose Foeatal anemia, indirectly ?? Is it study of MCA?? Ans:-In most specialist centers , serial measurement
of the peak systolic
velocity of the fetal middle
cerebral artery has replaced
amniocentesis for the detection
of fetal anemia. The anemic fetus
shunts blood preferentially to the brain to maintain adequate oxygenation. The velocity increase because
of increased cardiac output and
decreased blood viscosity (foetal anemia ) . But the technique, as in other fields of Obstet imaging should be used only with adequate training
and experience .
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