Supplementary Material for: Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

<b><i>Objectives:</i></b> To analyze the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetomaternal hemorrhage (FMH) and to compare it with standard biophysical assessment. <b><i>Data Sources:</i></b> Retrospective review of cases of FMH seen in our unit and systematic review of the literature. <b><i>Results:</i></b> We followed the MOOSE guidelines to review the literature. From 838 articles, 16 were selected. In total, 35 women, including 3 cases from our center and 32 obtained from the literature search were included. Diagnosis of FMH was always confirmed by laboratory tests. Patients were seen at 31 ± 5 weeks' gestation (range 16-39) and the most frequent indication for referral was decreased perception of fetal movements. Cardiotocography (CTG) upon admission was sinusoidal in 18 cases, nonreactive in 6, decelerative in 2 and tachycardic in one. MCA-PSV was abnormal in all cases but one. There were 2 perinatal deaths. The mean hemoglobin concentration at birth or at intrauterine transfusion was 4.8 ± 1.9 g/dl. <b><i>Discussion:</i></b> The most accurate predictor of FMH was fetal MCA-PSV. CTG was always abnormal but the pattern was frequently nonspecific. We suggest including fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.

<b><i>研究目的：</i></b> 分析大脑中动脉（middle cerebral artery, MCA）收缩期峰值流速（peak systolic velocity, PSV）在预测重度胎儿-母体出血（fetomaternal hemorrhage, FMH）中的作用，并将其与标准生物物理评估进行对比。<b><i>数据来源：</i></b> 对本医疗单元收治的胎儿-母体出血病例开展回顾性分析，并进行系统文献综述。<b><i>研究结果：</i></b> 本研究遵循MOOSE指南进行文献回顾。从838篇文献中筛选出16篇纳入分析，最终共纳入35例患者，其中3例来自本中心，32例来自文献检索结果。胎儿-母体出血的诊断均经实验室检查证实。患者就诊时孕周为31±5周（范围16~39周），最常见的转诊指征为孕妇自觉胎动减少。入院时胎心监护（cardiotocography, CTG）结果显示：正弦型18例、无反应型6例、减速型2例、心动过速型1例。除1例外，所有病例的MCA-PSV均检测异常。共发生2例围产儿死亡。分娩或接受宫内输血时的平均血红蛋白浓度为4.8±1.9 g/dl。<b><i>讨论：</i></b> 胎儿MCA-PSV是预测胎儿-母体出血的最准确指标。胎心监护结果常出现异常，但图形表现多无特异性。本研究建议将胎儿脑多普勒检查纳入胎动减少患者的评估流程，尤其适用于生物物理检测结果模棱两可的病例。