Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia-diagnosis and management
Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia-diagnosis and management
复制标题
DOI：
10.1016/j.ajog.2015.01.059
复制
发表时间：
2015-06-01
影响因子：
9.8
通讯作者：
Schenone, Mauro H.
中科院分区：
文献类型：
--
作者：
Mari, Giancarlo;Norton, Mary E.;Schenone, Mauro H.
目的：我们试图提供基于证据的指南，胎儿贫血的诊断和管理。方法：使用MEDLINE，PubMed，EMBASE和科克伦图书馆进行系统的文献综述。检索仅限于1966年至2014年5月发表的英文文章。优先考虑报告原创研究的文章，特别是随机对照试验，尽管查阅了综述文章和评论。在专题讨论会和科学会议上提出的研究摘要被认为不足以列入。还审查了证据报告和已发表的指南，并通过审查已识别文章的参考书目找到了其他研究。GRADE（建议评估、开发和评价分级）方法用于定义建议的强度和对证据质量进行评级。结果与建议：（1）超声多普勒测定大脑中动脉收缩期峰值流速（MCA PSV）可作为诊断胎儿贫血的首选技术，（2）羊水δ OD 450不可用于诊断胎儿贫血，（3）羊水δ OD 450可作为诊断胎儿贫血的辅助指标。（3）MCA-PSV评估应保留给有贫血胎儿风险的患者（MCA-PSV评价的适当技术包括评估靠近其起源的大脑中动脉，理想情况下为零度角，无需角度校正）;（4）如果胎儿被认为有严重胎儿贫血的重大风险，（MCA大于中位数的1.5倍或水肿），进行胎儿血液采样，准备宫内输血，除非怀孕的胎龄被认为与分娩有关的风险小于与手术有关的风险;（5）如果胎儿被认为有严重胎儿贫血的重大风险，则将患者转诊至具有侵入性胎儿治疗专业知识的中心;（6）MCA-PSV可用于确定贫血胎儿第二次输血的时机，或者，胎儿血红蛋白的预测下降可用于第二次手术的时间安排;和（7）胎儿处于胎儿贫血显著风险的妊娠在妊娠37-38周分娩，除非在此之前出现指征。
OBJECTIVE: We sought to provide evidence-based guidelines for the diagnosis and management of fetal anemia.METHODS: A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through May 2014. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology was used for defining the strength of recommendations and rating the quality of evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence.RESULTS AND RECOMMENDATIONS: We recommend the following: (1) middle cerebral artery peak systolic velocity (MCA-PSV) measured by ultrasound Doppler interrogation be used as the primary technique to detect fetal anemia; (2) amniotic fluid delta OD450 not be used to diagnosis fetal anemia; (3) MCA-PSV assessment be reserved for those patients who are at risk of having an anemic fetus (proper technique for MCA-PSV evaluation includes assessment of the middle cerebral artery close to its origin, ideally at a zero degree angle without angle correction); (4) if a fetus is deemed at significant risk for severe fetal anemia (MCA greater than 1.5 multiples of the median or hydropic), fetal blood sampling be performed with preparation for an intrauterine transfusion, unless the pregnancy is at a gestational age when the risks associated with delivery are considered to be less than those associated with the procedure; (5) if a fetus is deemed at significant risk for severe fetal anemia, the patient be referred to a center with expertise in invasive fetal therapy; (6) MCA-PSV be considered to determine the timing of a second transfusion in fetuses with anemia, and, alternatively, a predicted decline in fetal hemoglobin may be used for timing the second procedure; and (7) pregnancies with a fetus at significant risk for fetal anemia be delivered at 37-38 weeks of gestation unless indications develop prior to this time.