The New Indian Journal of OBGYN. Epub Ahead of Print

A study of fetal umbilical artery and middle cerebral artery doppler velocimetry before and after treatment of severe maternal iron deficiency anaemia

Suhail Rafiq,Sheema Posh,Irtifa Jeelani,Musaib Ahmad Dar, Shahnaz Tang

ABSTRACT

Objective: To evaluate the effect of vascular adaptation and extent of compensatory changes in the fetus with the change in maternal Hb levels and to study maternal and perinatal outcome after treatment of maternal iron deficiency anaemia. Methods: The present study was an observational prospective study conducted on 50 pregnant women from January 2016 to June 2017. The study population was divided into two groups: group A - patients with moderate anaemia (Hb: 7- 9 gm/dl) and group B - patients with severe anaemia (Hb < 7 gm/dl). Group A received parenteral iron preparation and group B received blood transfusion or packed RBCs until Hb exceeded 7gm/dl, then parenteral iron was used. Maternal Hb and color doppler were performed before and after treatment of anaemia. Results: There was a significant increase in Hb levels in all patients after treatment of anaemia (p-value 0.018). There was a decrease in the umbilical artery RI after treatment of maternal anaemia in both the groups and the decrease was more in those who received blood transfusion. A comparison for UA RI for both the groups before and after treatment was statistically significant (p = 0.032 for group A and p=0.0001 for group B).There was an improvement in MCA RI in both the groups after treatment of anaemia (the p-value for group A and group B being 0.001 and 0.0001 respectively i.e. statistically significant). The C/U ratio was normalized to >1.1 in both the study groups after treatment of anaemia (p- value in group A being 0.653) and group B being 0.0001(statistically significant) respectively. After treatment of iron deficiency anaemia, normalization of doppler indices was observed. Conclusion: Our data support the fact that maternal haemoglobin content of <7g/dl is strongly associated with marked fetal hemodynamic adaptation and must be treated with acute red cell transfusion. Moderate anaemia (>7g/dl) is not sufficient to trigger fetal blood flow redistribution and can be treated with parenteral iron.