When I was 26 weeks pregnant, I began weekly Middle Cerebral Artery (MCA) Doppler assessments at my maternal fetal medicine clinic, as my infant was at risk of hemolytic disease of the fetus and newborn (HDFN).
What is an MCA Doppler assessment?
The MCA is located in the brain, and the velocity of blood movement is measured to detect anemia. This velocity is measured and compared to the gestational age of the fetus. Based on this information, a Multiples of the Mean (MoM) is calculated. A measurement of 1.5 MoM or higher indicates anemia.
In my case, the MoM increased weekly until it reached the 1.5 MoM at 29 weeks gestation. Every other week, the maternal fetal medicine doctor would also conduct a biophysical profile (BPP) and growth scan. This would give our doctor the opportunity to ensure that the baby was thriving.
Both scans were performed by an ultrasound technician. The technician would use an ultrasound machine to perform an abdominal ultrasound to collect the MCA Doppler and BPP. This information could be crucial in determining if a child has developed HDFN.
Battling the diagnosis and my mental health
The weekly checks caused me anxiety–it was an uneasy feeling like none other. Each week, I knew there was the potential of an HDFN diagnosis, which could be serious and require blood transfusions. If that didn’t cause enough anxiety, I had the added stress of knowing that there was not a doctor in my area who had experience in giving intrauterine blood transfusions. This meant that if my child became anemic, I would have to travel three to four hours by car to get the care my daughter would need.
My worry became a reality at 29 weeks gestation, when her MoM finally hit the 1.5 mark. My MFM came in and delivered the news that I needed to be seen by the transfusion specialist in Dallas, TX. We traveled there on a Friday, but when they performed the MCA Doppler and calculated the MoM, their data stated that the MoM was only 1.43. At this value, a transfusion is not needed. They then instructed me to come back on the following Monday to check one more time before releasing me back to my local MFM.
My first transfusion
On the following Monday, it had jumped to 1.51 MoM, requiring that a transfusion be done. Unfortunately, the doctor at that facility who performs the transfusions was out of office on vacation. The MFM that was treating me told me that we would not be able to wait for his return–my baby needed a transfusion now.
He called the only other doctor in Texas who performs intrauterine blood transfusions, and fortunately, that doctor decided to take me in as a patient. We drove five hours from Dallas to Houston, TX and received our first transfusion.
Even after receiving a transfusion, the weekly MCA checks were still necessary. Doctors say that they are not as accurate after the first blood transfusion, but it is the only way to keep monitoring the baby. My daughter had two more transfusions after the initial transfusion and was delivered at 35 weeks gestation via cesarean. We are now both happy and healthy, despite the challenges in our journey.
