An assessment on foeto-maternal haemorrhage

Abstract

INTRODUCTION AND OBJECTIVES: Foeto-maternal haemorrhage leading to maternal sensitization against foetal antigens occurs predominantly during delivery. This leads to rhesus haemolytic disease of the newborn and foetus in subsequent pregnancies. Accurate estimation of volume of such haemorrhage is important to provide the correct dose of anti-D for the prevention of haemolysis in subsequent pregnancies. Objective was to assess the volume and determinants offoeto-maternal haemorrhage at delivery. METHODS: A prospective descriptive study was conducted among 625 mothers admitted to the Professorial Obstetric unit for delivery from 2006 June. 2cc of Ethylene Diamine Tetra Acetic acid anticoagulated blood was taken within 2 hours of partus. Volume of foeto-maternal haemorrhage was assessed using the Keilhauer test.A minimum of 6000 adult red cells was counted to achieve a reasonable precision and to narrow 95% confidence limits to 95%. The volume of the haemorrhage was reported to the ward for necessary action An interviewer-administered questionnaire was filled at the time ofvenepuncture. RESULTS: Only 1.76% (n=l l ) mothers had more than 4ml hemorrhage (Range 6ml-52ml) to be qualified as a large bleeder, requiring additional doses ofanti-D. The toal number oflarge bleeders identified were too small to make inferences on determinants of large haemorrhages but still, some important observations were made: None of the mothers were multiparous but most were primi (n=6). All were single cephalic presentations (n=l l) delivered vaginally (n=9) or by a caesarean section (n=2). One had a placenta praevia, but none of the pregnancies were . complicated with antepartum or postpartum haemorrhage, polyhydramnios, manual removal of placenta or external cephalic versions or asssisted by instruments which are already known factors for such large bleeds. CONCLUSION: Clinically significant foeto-maternal haemorrhage requiring additional anti-D was <2% in our study population. Prospective epidemiological study including a larger study population will help to identify factors associated with increasing volume of foetal haemorrhage