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Foetomaternal Haemorrhage (FMH): A Case for Routine Screening

Received: 17 January 2014     Published: 20 February 2014
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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.

Published in Journal of Gynecology and Obstetrics (Volume 1, Issue 3)
DOI 10.11648/j.jgo.20130103.11
Page(s) 11-15
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Foetomaternal Haemorrhage, Kleihauer-Betke, Prevalence, Foetus

References
[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.
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    Samuel S. Antwi-Baffour, Martin Amega-Yevu, Ransford Kyeremeh, Seidu A. Mahmood, Patrick F. Ayeh-Kumi. (2014). Foetomaternal Haemorrhage (FMH): A Case for Routine Screening. Journal of Gynecology and Obstetrics, 1(3), 11-15. https://doi.org/10.11648/j.jgo.20130103.11

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    ACS Style

    Samuel S. Antwi-Baffour; Martin Amega-Yevu; Ransford Kyeremeh; Seidu A. Mahmood; Patrick F. Ayeh-Kumi. Foetomaternal Haemorrhage (FMH): A Case for Routine Screening. J. Gynecol. Obstet. 2014, 1(3), 11-15. doi: 10.11648/j.jgo.20130103.11

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    AMA Style

    Samuel S. Antwi-Baffour, Martin Amega-Yevu, Ransford Kyeremeh, Seidu A. Mahmood, Patrick F. Ayeh-Kumi. Foetomaternal Haemorrhage (FMH): A Case for Routine Screening. J Gynecol Obstet. 2014;1(3):11-15. doi: 10.11648/j.jgo.20130103.11

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  • @article{10.11648/j.jgo.20130103.11,
      author = {Samuel S. Antwi-Baffour and Martin Amega-Yevu and Ransford Kyeremeh and Seidu A. Mahmood and Patrick F. Ayeh-Kumi},
      title = {Foetomaternal Haemorrhage (FMH): A Case for Routine Screening},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {1},
      number = {3},
      pages = {11-15},
      doi = {10.11648/j.jgo.20130103.11},
      url = {https://doi.org/10.11648/j.jgo.20130103.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20130103.11},
      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.},
     year = {2014}
    }
    

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  • TY  - JOUR
    T1  - Foetomaternal Haemorrhage (FMH): A Case for Routine Screening
    AU  - Samuel S. Antwi-Baffour
    AU  - Martin Amega-Yevu
    AU  - Ransford Kyeremeh
    AU  - Seidu A. Mahmood
    AU  - Patrick F. Ayeh-Kumi
    Y1  - 2014/02/20
    PY  - 2014
    N1  - https://doi.org/10.11648/j.jgo.20130103.11
    DO  - 10.11648/j.jgo.20130103.11
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 11
    EP  - 15
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20130103.11
    AB  - 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.
    VL  - 1
    IS  - 3
    ER  - 

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Author Information
  • Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana

  • Department of Medical Laboratory Services, Dangbe West District Hospital, Dangbe West District, Greater Accra Region, Ghana

  • Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana

  • Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana

  • Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana

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