Study On Pregnancy Diagnosing In Fetal α-thalassemia With Middle Cerebral Artery Blood Flow Velocity And Evaluating Their Heart Function With Fraction Shortening And Ejection Fraction Of The Left Ventricle

Objective:Study on the value that evaluate fetalα-thalassemia's pregnancy prognosis by Color Doppler ultrasound examination on the middle cerebral artery(MCA) blood flow velocity and by M-mode ultrasonic cardiogram examination on the fraction shortening(FS) and the ejection fraction(EF) of the left ventricle.Method:78 singleton pregnancies at risk due to fetal thalassemia,at 16-40 week's gestation,were performed with two-dimensional ultrasound imaging, Color Doppler ultrasound imaging and the M-mode ultrasonic cardiogram imaging.The MCA peak systolic velocity(PSV),the MCA end diastolic velocity (EDV),the FS and the EF of left ventricle were measured.There are 36 thalassemic fetuses and 42 normal fetuses in this study.Among these thalassemic fetuses,18 hadα-thalassemic major(The Hemoglobin Bart's Hydrops Foetus syndrome),4 hadα-thalassemia Intermedia,14 hadα-minor.All the fetuses will be visited pregnancy prognosis until the pregnancy procedure end.Comparing the MCA-PSV,the MCA-EDV,the FS and EF of left ventricle between thalassemic group and non-thalassemic group.Estimates the prognostic significance and the heart function of fetalα-thalassemia by MCA-PSV＞1.29 multiples of the median(MOM)and FS＜0.28,EF＜60%.Results:MCA-PSV increased with increasing gestational age in All fetuses.The group of fetuses with Hemoglobin"Bart's Hydrops Fetalis Syndrome had the signigicantly higher MCA-PSV compared to the other groups(P＜0.001).EF and FS didn't increase with increasing gestational age in All fetuses.The group of fetuses with Hemoglobin Bart's Hydrops Fetalis Syndrome had the significantly lower FS compared to the normal groups(P＜0.01).However,there were no statistical significant difference in the FS,EF between the other groups(P＞0.05). Combine the two-dimensional ultrasound examination with FS＜0.28,EF＜60% diagnosing the fetalα-thalassemic major,have a specificity of 28%,have a susceptibility of 86%.Combine the two-dimensional ultrasound examinationwith MCA-PSV＞1.29MOM predicting the fetalα-thalassemic major,have a specificity of 94%,have a susceptibility of 100%.MCA-PSV＞1.29MOM by Color Doppler ultrasound imaging have the higher specificity and susceptibility in prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome(P＜0.05).Conclusion:Middle cerebral artery peak systolic velocity by Color Doppler ultrasound can be used to be a noninvasive tool to predict Hemoglobin Bart's Hydrops Fetalis Syndrome.FS and EF of the left ventricle by M-mode ultrasonic cardiogram have the lower sensitiveness in the prediction of Hemoglobin Bart's Hydrops Fetalis Syndrome.However,FS and EF of the left ventricle can be used to a significant index in evaluating heart function of the fetalα-thalassemic major.