Volume 1, Issue 3, November 2013, Page: 11-15
Foetomaternal Haemorrhage (FMH): A Case for Routine Screening
Samuel S. Antwi-Baffour, Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
Martin Amega-Yevu, Department of Medical Laboratory Services, Dangbe West District Hospital, Dangbe West District, Greater Accra Region, Ghana
Ransford Kyeremeh, Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
Seidu A. Mahmood, Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
Patrick F. Ayeh-Kumi, Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
Received: Jan. 17, 2014;       Published: Feb. 20, 2014
DOI: 10.11648/j.jgo.20130103.11      View  3420      Downloads  211
Abstract
Background: Foetomaternal haemorrhage (FMH) over the years has been a matter of a major concern as it occurs asymptomatically and is one of the most common disorders responsible for foetal death. FMH occurs when there is leakage of foetal blood into maternal circulation due to breach in the physiological barrier between their circulations. In most pregnancies about 0.1ml foetal bleed occurs and it could be acute or chronic. The detection and quantification of any quantity of foetal red blood cells in maternal circulation would be important for obstetrical management of pregnant women. But FMH is not part of the routine screening done for pregnant women in many areas. Aims/objectives: The aim of this study was to assess the prevalence of FMH among pregnant women attending antenatal clinic in a District Hospital towards recommending the testing as part of the routine screening of pregnant women. Methods: A Kleihauer-Betke test (KBT) was used to quantify foetal red blood cells in venous blood from 212 expectant mothers recruited for the study. Thin blood smear (film) was prepared, dried, fixed, incubated in an acid solution and stained with eosin. They were then examined under the microscope. The foetal cells were counted and reported as a percentage of the adult cells and the FMH was calculated from that. Antibody screening was also done using the Coombs indirect test. Results: There was FMH prevalence rate of 0.5% when the cut-off of FMH was 30.0 ml. Also, 2% of the study group had antibodies in their serum. Conclusion: with the majority of the study population showing FMH below the level that could harm the foetus, it can be concluded that, the screening may not be mandatory but all at risk (rhesus negative) women should be screened routinely.
Keywords
Foetomaternal Haemorrhage, Kleihauer-Betke, Prevalence, Foetus
To cite this article
Samuel S. Antwi-Baffour, Martin Amega-Yevu, Ransford Kyeremeh, Seidu A. Mahmood, Patrick F. Ayeh-Kumi, Foetomaternal Haemorrhage (FMH): A Case for Routine Screening, Journal of Gynecology and Obstetrics. Vol. 1, No. 3, 2013, pp. 11-15. doi: 10.11648/j.jgo.20130103.11
Reference
[1]
Dziegiel M H, Nielsen L K and Berkowicz A. Detecting fetomaternal hemorrhage by flow cytometry. Curr Opin Hematol 2006; 13: 490-5.
[2]
Dhanraj D, Lambers D. The incidences of positive Kleihauer-Betke test in low-risk pregnancies and maternal trauma patients. Am J Obstet Gynecol 2004; 190:1461.
[3]
Dziegiel, M. H., Nielsen, L. K. & Berkowicz, A. 2006. Detecting fetomaternal hemorrhage by flow cytometry. Curr Opin Hematol, 13, 490-5
[4]
Sebring E and Polesky H. Foetomaternal haemorrhage: incidence, risk factors, time of occurrence, and clinical effects. Transfusion 1990; 30: 344–357.
[5]
Rubod C, Deruelle P, Le Goueff F, Tunez V, Fournier M and Subtil D. Long-term prognosis for infants after massive Foetomaternal haemorrhage. Obstetric Gynecology 2007; 110: 256–260.
[6]
Salim R, Ben-Shlomo I, Nachum Z, et al. The incidence of large fetomaternal hemorrhage and the Kleihauer-Betke test. Obstet Gynecol 2005; 105:1039
[7]
Adeniji AO, Mabayoje VO, Raji AA, et al. Feto - maternal haemorrhage in parturients: Incidence and its determinants. J Obstet Gynaecol 2008; 28:60.
[8]
E Austin, S Bates, M de Silva, D Howarth, A Lubenko, M Rowley, M Scott, E Thomas, J White, M Williams. Guidelines for the Estimation of Fetomaternal Haemorrhage. Working Party of the British Committee for Standards inHaematology, Transfusion Taskforce 2008; Version 15: 1-23.
[9]
Austin E, Bates S, De Silva M, Howarth D, Lubenko A, Rowley M et al. Guidelines for the Estimation of Fetomaternal Haemorrhage, Working Party of the British Committee for Standards in Haematology, Transfusion Taskforce. 100 White Lion Street: British Society for Haematology. 2009.
[10]
Mollison, P.L. (1972). Quantitation of transplacental haemorrhage. British Medical Journal, 3, 31–34.
[11]
Dacie JV and Lewis SM. Practical Haematology. 8th ed. 2005.
[12]
AABB technical manual. 5th edition. AABB, 2005: 897 – 898.
[13]
Bianchi DW, Romero R. Biological implications of bi-directional fetomaternal cell traffic: a summary of a National Institute of Child Health and Human Development-sponsored conference. J Matern Fetal Neonatal Med 2003; 14:123.
[14]
Rubod C, Houfflin V, Belot F, Ardiet E, Dufour P and Subtil D. Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops. Fetal Diagn Ther 2006; 21: 410-413.
[15]
David M, Smidt J, Chen FC, Stein U and Dudenhausen JW. Risk Factors For Fetal To-Maternal Transfusion In Rh D-Negative Women--Results Of A Prospective Study On 942 Pregnant Women. J Perinat Med 2004; 32: 254-7.
[16]
Augustson B M, Fong EA, Grey D E, Davies JI and Erber WN. Postpartum anti-D: can we safely reduce the dose? Med J Aust 2006; 184: 611-3.
[17]
Kizza A and Rogo K. Feto-maternal haemorrhage in Kenya. East African Medical Journal 1990; 67(11): 801-807.
[18]
Leavitt BG, Huff DL, Bell LA and Thurnau GR. Placental Drainage Of Fetal Blood At Cesarean Delivery And Feto Maternal Transfusion; A Randomized Controlled Trial. Obstet Gynecol 2007; 110: 608-611.
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