A 25-year-old-woman with positive titer of 1:256 for anti-E antibodies was referred to our unit at 38 weeks. The ultrasound findings were:

• high middle cerebral artery systolic velocity
• normal umbilical Doppler
• pericardia effusion
• dilated heart
• the thickness of the inter-ventricular septum was in the high limits
• pathological mitral Doppler with E>A
• high Vmax in the ductus venosus
• there were no hepatomegaly and splenomegaly
• normal placental thickness

The ultrasonographics findings of fetal anemia were followed by a cardiotocography that showed a sinusoidal rhythm and a moderate tachycardia (150bpm). The fetus was also not very active during the scan.

The baby was delivered in good conditions by a cesarean section (3,200g). No other anomaly was noted only a moderate pallor. The hemoglobin was 7g and the bilirubin was 99 in the second hour of life.  The baby underwent a exsanguinotransfusion.

Normal umbilical Doppler

The high middle cerebral artery systolic velocity

Note the thickness of the interventricular septum (upper limit):

Abnormal Mitral Doppler  with E>A

Note the dilated heart with a pericardial effusion

Ductus venosus  Doppler

Note the sinusoidal rhythm and a moderate tachycardia (150bpm)

Note the normal placental thickness. There was no splenomegaly.