Original article

Blood Transfusion - 3 2018 (May - June)

Mild-to-moderate foeto-maternal haemorrhage in the third trimester and at term of pregnancy: quantitative determination and clinical-diagnostic evaluation

Authors

Key words: foeto-maternal haemorrhage, cytofluorimetric assay, pregnancy, foetal anaemia
Publication Date: 2017-04-19

Abstract

Background. Foeto-maternal haemorrhage (FMH), a gestational event that occurs before or during delivery, consists of a loss of foetal blood into the maternal circulation. FMH occurs more frequently during the third trimester or labour both in normal and complicated pregnancies. In the case of alloimmunisation, the maternal immunological response and the severity of the resulting foetal or neonatal disease depend on the amount of foetal blood that passes into the maternal circulation. The aim of this study was to determine FMH in the third trimester and at term of pregnancy and to evaluate the role of clinical and ultrasound markers in the prediction of FMH.
Materials and methods. FMH was quantified by cytofluorimetric testing at 28 to 35 weeks of gestation in 223 women and at term in 465 women, all with risk factors. Foetal evaluation included foetal movement profile, middle cerebral artery peak velocity of systolic blood flow (MCA-PSV) and cardiotocographic monitoring.
Results. All women tested negative for FMH in the third trimester. Four patients (0.9%) tested positive at term, with estimated volumes of bleeding of 2.2, 8.1, 12.3 and 39.8 mL. Three FMH cases (75%) had a non-reassuring cardiotocography compared to 8.9% (42/461) of women without FMH (p=0.003) and two FMH cases reported a reduction in foetal movements reduction compared to four of those without FMH (p=0.001). Mean MCA-PSV was normal in both the groups with and without FMH (p=0.22).
Discussion. FMH is rare in pregnancy and at term. Cytofluorimetric testing is a specific method to detect mild-to-moderate FMH even when the MCA-PSV is not informative. Mild-to-moderate FMH is significantly associated with reduced foetal movements and non-reassuring cardiotocographic monitoring.

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Authors

Fausta Beneventi - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Chiara Cavagnoli - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Elena Locatelli - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Silvia Bariselli - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Margherita Simonetta - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Gianluca Viarengo - Immunotransfusion Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Cesare Perotti - Immunotransfusion Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

Arsenio x Arsenio Spinillo - Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy

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