MCA Doppler Study: Fetal middle cerebral artery Doppler velocimetry to determine the timing of second and subsequent fetal blood transfusions in the treatment of fetal anaemia secondary to red cell alloimmunisation- a randomsied controlled trial. ACTRN12608000643370

This trial is currently recruiting. The trial is open for other centres to join the study.

Red cell alloimmunisation is estimated to affect 0.1 to 0.6% of all live births. Treatment of the resultant fetal anaemia with intrauterine fetal blood transfusion has been associated with survival rates in excess of 90%. However, intrauterine fetal blood sampling and transfusion is an invasive procedure, with recognised complications, which may result in the need for early birth, and rarely mortality. More recently, reports have emerged utilising Doppler ultrasound to measure the fetal middle cerebral artery (MCA) peak systolic velocity (PSV) to determine the presence of fetal anaemia. Systematic review of the literature has indicated a lack of information from randomised controlled trials comparing this technique with standard measures based on prediction in the rate of fall in the fetal haemoglobin. Cohort studies reporting the use of fetal MCA PSV in this setting yield conflicting results. Clearly, high quality trials are a priority to assess the role of MCA-PSV in determining the timing of second and subsequent fetal intrauterine blood transfusions, and the impact this has on fetal and neonatal morbidity, when compared with current standard care.

The aims of this trial are to assess in the fetus where one intrauterine fetal transfusion has been performed for anaemia due to red cell alloimmunisation, whether fetal middle cerebral artery (MCA) peak systolic velocity (PSV) can be safely used to determine the timing of second and subsequent fetal blood transfusions, without increasing the risk of adverse fetal and neonatal health outcomes.

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