|Premature Restriction of Foramen Ovale in an Anemic Fetus From a Rhesus-negative Mother: A Case Report|
|Homeira Vafaei1, Nasrin Asadi1, Ali Mohammad Shakibafard2, Maryam Kasraeian1, Neda Rahimirad1, Shaghayegh Moradi Alamdarloo3, Shohreh Roozmeh1, Kamran Hessami4|
|1Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2Division of Pediatric Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
3Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
IJWHR 2021; 9: 156-157
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Keywords : Fetus, Anemia, Middle cerebral artery, Congenital heart disease, Rhesus factor, Erythroblastosis
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The fetal middle cerebral artery-peak systolic velocity (MCA-PSV) is a noninvasive tool for detection of intrauterine fetal anemia. Premature restriction of foramen ovale (FO) may prevent proper blood supply to the fetal brain. We presented a 29-year-old Rhesus-negative mother who had been referred to our center due to positive indirect Coombs test. A single live intrauterine fetus at 30 weeks of gestation was observed with normal MCA-PSV- multiples of the median (MoM). The mother was under weekly follow up due to an isoimmunized pregnancy. In the third week of follow-up, the MCA-PSV- MoM was within the normal range though fetal echocardiography showed that the findings were in favor of premature restriction of FO; so premature delivery was decided at the same day. A boy was delivered with significant paleness, hemoglobin level of 3 g/dL, positive direct Coombs test, and reticulocyte count of 20%. These findings resulted in a significant intrauterine hemolysis process due to Rh alloimmunization not detected by Doppler examination of MCA- PSV during pregnancy. The aim of this study was to show that MCA-PSV- MoM may not be a diagnostic method for detection of possible anemia in the fetus with congenital heart disease.
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