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Amniotic Fluid OD 450 Values Accurately Predict Severe Fetal Anemia in D-Alloimmunization

From the Department of Obstetrics and Gynecology, and Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands.

Address reprint requests to: Frank P. H. A. Vandenbussche, MD, PhD, Leiden University Medical Center, Department of Obstetrics, K6-32, P.O. Box 9600, 2300 RC Leiden, the Netherlands; E-mail: frank.vandenbussche{at}lumc.nl.

OBJECTIVE: To assess the diagnostic accuracy of amniotic fluid OD 450 values in the second and third trimesters of D-alloimmunized pregnancies.

METHODS: We searched our database for singleton D-alloimmunized pregnancies with nonhydropic fetuses, where amniocentesis was performed within 4 days of first fetal blood sampling. Amniotic fluid OD 450 values were plotted on an extrapolated Liley’s chart. Sensitivity and specificity were calculated for two commonly used cutoff levels, Liley’s zone 3 and the upper third of Liley’s zone 2. Severe fetal anemia was defined as a hemoglobin concentration of more than 5 standard deviations below the normal mean for corresponding gestational age.

RESULTS: Seventy-nine pregnancies met our inclusion criteria. Overall accuracy of the extrapolated Liley’s curve in predicting severe fetal anemia was 75% (95% confidence interval [CI] 64, 84) for zone 3 and 86% (95% CI 77, 93) when the upper third of zone 2 was included. Sensitivity of OD 450 values in Liley’s zone 3 or the upper third of Liley’s zone 2 was 95% (95% CI 74, 100) before and 98% (95% CI 89, 100) after 27 weeks.

CONCLUSION: Liley’s extrapolated curve predicts severe fetal anemia with reasonable accuracy and high sensitivity.

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