Study of feto-maternal haemorrhage during third trimester of pregnancy and immediate postpartum period in a secondary care hospital in India

Authors

  • Rashmi Department of Gynaecology & Obstetrics, Jalpaiguri Government Medical College, Jalpaiguri, West Bengal, India https://orcid.org/0009-0005-7810-5616
  • Adrija Ghoshal Department of Gynaecology & Obstetrics, Jalpaiguri Government Medical College, Jalpaiguri, West Bengal, India https://orcid.org/0009-0009-0137-7815
  • Selim Akhtar Department of Gynaecology & Obstetrics, Jalpaiguri Government Medical College, Jalpaiguri, West Bengal, India https://orcid.org/0000-0002-0780-0815
  • Tapas Kumar Bera Department of Gynaecology & Obstetrics, M.R. Bangur Hospital, Kolkata, West Bengal, India
  • Animesh Dasgupta Department of Gynaecology & Obstetrics, M.R. Bangur Hospital, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243942

Keywords:

Fetomaternal haemorrhage, Kleihauer Betke test, Pregnancy, Isoimmunization

Abstract

Background: Feto maternal haemorrhage (FMH) & isoimmunisation leads to erythroblastosis fetalis. Post partum Rh anti-D immunoglobulin within 72 hours can significantly reduce the incidence of alloimmunization but about 1.8% women become immunised due to ‘silent’ FMH during third trimester of pregnancy. To find out the incidence & volume of FMH during third trimester of pregnancy and just after delivery. Secondary objective was to consider the justified dose of anti-D immune globulin required after delivery in Rh negative mothers.

Methods: After getting approval from institutional ethics committee, we conducted a prospective observational study considering the inclusion and exclusion criteria. We took three maternal blood samples from each mother- at 28, 32 weeks & within 6 hours of delivery for performing Kleihauer Betkes test to detect FMH and its amount.

Results: 19 mothers out 0f 100 in our study developed FMH. Out of 19 mothers, 16 (84.2%) mothers had <1 ml Volume of haemorrhage and 3 mothers (15.8%) had 1-3 ml Volume of haemorrhage.

We found FMH is statistically associated with maternal blood pressure, mode of placenta delivery & number of foetuses.

Conclusion: Though incidence of FMH is low in antepartum period than intrapartum & postpartum period and incidence of large FMH is significantly lower, it is indeed needed to test the volume of FMH in every Rh-negative pregnancy, so that antenatal prophylaxis can be given and no silent bleeds cause isoimmunisation. Routine testing of FMH and subsequent patient specific adjusted dose to prevent isoimmunization can be cost effective.

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References

Kleihauer E, Braun H, Betke K, “Demonstration von Fetalem hemoglobin in der Erythrocyteneinesblutaus-strichs. Klinische Wochenschrift. 1957;35(12):637-38

Chandra T, Gupta A. Frequency of ABO and rhesus blood groups in blood donors. Asian J Transfus Sci. 2012;6(1):52-3.

Nazaneen S. "Study of feto-maternal haemorrhage in later part of pregnancy with special reference to rh negative mothers." IOSR J Den Med Sci. 2017;16(8):83-9.

Bowman JM, Pollock JM, Penston LE. Fetomaternal transplacental hemorrhage during pregnancy and after delivery. Vox Sang. 1986;51(2):117–21.

Renaer M, de Putte I Van, Vermylen C. Massive feto-maternal hemorrhage as a cause of perinatal mortality and morbidity. Eur J Obstet Gynecol Reprod Biol. 1976;6(3):125–40.

Adeniji AO, Mabayoje VO, Raji AA, Muhibi MA, Tijani AA, Adeyemi AS. Feto - maternal haemorrhage in parturients: Incidence and its determinants. J Obstet Gynaecol. 2008;28(1):60-3.

Wit H, Nabbe KC, Kooren JA, Adriaansen HJ, Roelandse-Koop EA, Schuitemaker JH, et al. Reference values of fetal erythrocytes in maternal blood during pregnancy established using flow cytometry. Am J Clin Pathol. 2011;136(4):631-6.

Akorsu EE, Acquaye JK, Benneh AA, Oppong SA, Olayemi E. Fetomaternal hemorrhage among pregnant women in Accra, Ghana. Int J Gynaecol Obstet. 2019;146(3):333-8.

Salim R, Ben-Shlomo I, Nachum Z, Mader R, Shalev E. The incidence of large fetomaternal hemorrhage and the Kleihauer-Betke test. Obstet Gynecol. 2005;105(5):1039-44.

Lubusky M, Simetka O, Studnickova M, Prochazka M, Ordeltova M, Vomackova K. Fetomaternal hemorrhage in normal vaginal delivery and in delivery by cesarean section. Transfusion. 2012;52(9):1977-82.

David M, Smidt J, Chen FC, Stein U, 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(3):254-7.

Augustson BM, Fong EA, Grey DE, Davies JI, Erber WN. Postpartum anti-D: can we safely reduce the dose? Med J Aust. 2006;184(12):611-3.

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Published

2024-12-27

How to Cite

Rashmi, Ghoshal, A., Akhtar, S., Bera, T. K., & Dasgupta, A. (2024). Study of feto-maternal haemorrhage during third trimester of pregnancy and immediate postpartum period in a secondary care hospital in India. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(1), 152–157. https://doi.org/10.18203/2320-1770.ijrcog20243942

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Original Research Articles