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(2) The most sensitive parameters in predicting Hb Bart anemia appear to be the cardiac diameter\u2013to\u2013thoracic diameter ratio, middle cerebral artery peak systolic velocity, and placental thickness. (3) Several other ultrasound markers are helpful in increasing specificity, such as hepatosplenomegaly. (4) Hydrops fetalis is not a consequence of heart failure but rather of hypervolemia and high vascular permeability of fetuses, whereas heart failure is a very late consequence of a long\u2010standing overworked heart. 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