Foetomaternal Haemorrhage (FMH): A Case for Routine Screening

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.