Kleihauer-Betke Research Articles

False positive Kleihauer results: an unusual cause in a postnatal patient in remission from acute myeloid leukaemia

A 34-year-old woman, in remission from acute myeloid leukaemia, had a positive postnatal Kleihauer result. Following our standard local protocol for positive Kleihauer tests in Rh-D negative patients, the specimen was referred for confirmatory testing, which proved the result to be false positive. Hereditary persistence of foetal haemoglobin was excluded as a Kleihauer test performed in a pregnancy prior to the development of leukaemia was negative. Further testing confirmed mild elevation of foetal haemoglobin (HbF) and increased F-cells. Elevated-HbF levels have been widely reported in patients with haematological malignancy. In this case, the patient was confirmed to be in a true molecular remission from leukaemia and yet appeared to have a residual clonal population of HbF erythrocytes; the significance of this finding remains unclear. This case also highlights the importance of confirmatory testing of suspected foeto-maternal haemorrhage, as not all positive Kleihauer tests are true positives.

ABO Fetomaternal Compatibility Poses a Risk for Massive Fetomaternal Transplacental Hemorrhage

In the third trimester, fragility of the placental membrane increases the risk of fetomaternal transplacental hemorrhage (FMH), which can result in severe fetal anemia from the hemorrhage itself or from the subsequent effects of isoimmunization. ABO incompatibility between the mother and fetus is associated with a significantly reduced risk of isoimmunization. The investigators hypothesized that this protective effect might be due to reduced risk of fetomaternal hemorrhage in ABO incompatible mother-fetus pairs, and that ABO compatible pairs might be at increased risk of fetomaternal hemorrhage. Investigators evaluated 8 cases of severe fetomaternal transfusion identified among 17,000 deliveries at a tertiary care center between 2003 and 2007. Blood group compatibility between the mother and fetus was evaluated and the perinatal outcome assessed. The Kleihauer-Betke test was used to diagnose FMH. The mean gestational age in the study population was 35 weeks (range 32–39) and the mean fetal weight was 2750 gm (range 2140–3420). All deliveries were operative. Among the 8 infants, 6 (75%) had adverse outcomes after FMH. Four of the infants were affected by posthypoxic damage of varying severity, and there were 2 perinatal deaths. Seven of the 8 cases had fetomaternal ABO compatibility between the mother and fetus. These findings suggest that ABO compatibility between the mother and fetus significantly increases the risk of severe fetomaternal hemorrhage. For cases with severe fetal anemia, the investigators recommend that resuscitation in utero by intrauterine transfusion should be considered before the 33rd week of gestation.

Flowcytometric assessment of fetomaternal hemorrhage during external cephalic version at term

External cephalic version (ECV) at term is a safe procedure and reduces the incidence of cesarean sections for breech presentation. One of the known complications, however, is an ECV-related disruption of the placental barrier and a subsequent transfusion of fetal blood into maternal circulation. While the incidence of ECV-related fetomaternal hemorrhage (FMH) has been determined recently in a large trial using a manual Kleihauer-Betke test (KBT), questions remain on the amount of ECV-related FMH. KBT, which detects fetal red blood cells (RBC) on the basis of acidic resistance of fetal hemoglobin (HbF), is known to be a sensitive test, yet prone to procedural errors limiting its accuracy in quantifying FMH. In this study we investigated 50 patients for FMH before and after ECV, using a dual-color flow cytometric test kit with a lower limit of quantification of 0.05% fetal RBC in maternal peripheral blood. Three patients had a quantifiable increase of fetal RBC detected after ECV (0.06%; 0.08%; 0.1%). None of these subtle increments was predictable by ECV-related clinical parameters or translated into fetal compromise. Using a sensitive and accurate flow cytometric test method, our data provide further assurance to mothers on the safety of ECV at term.

Large Fetomaternal Hemorrhage: Prenatal Predictive Factors for Perinatal Outcome

We sought to identify prenatal predictive factors for perinatal outcome and to estimate fetal hemoglobin (Hb) levels in large fetomaternal hemorrhages (transfused blood volume [TBV] > 20 mL) by performing a case-series study ( N = 32). Perinatal outcome was favorable (F group, N = 22) and poor (P group, N = 10: four fetal deaths, three postnatal deaths, three cases of severe anemia). Median TBV was 25 mL for the F group and 325 mL for the P group ( P < 0.0001) and median Hb concentration at birth was 15 g/dL for the F group and 5 g/dL for the P group ( P < 0.0001). Receiver operating characteristic analysis revealed that a Kleihauer-Betke test value above 2.5% was the best threshold for predicting adverse outcome, with sensitivity of 100% (95% confidence interval [CI] 76 to 100) and specificity of 96% (95% CI 77 to 100). In utero estimated Hb concentration best correlated with Hb level at birth when calculated using TBV corrected for fetoplacental weight ( P < 0.0001, R(2) = 0.874). The value obtained in the Kleihauer-Betke test was a prognostic factor, and TBV corrected for fetoplacental weight was the best biological marker for assessing fetal Hb level.

ABO fetomaternal compatibility poses a risk for massive fetomaternal transplacental hemorrhage

Severe fetomaternal transplacental hemorrhage increases the risk of fetal anemia. In the third trimester, the syncytiotrophoblast becomes thinner, especially in areas where it comes into intimate contact with villous capillaries, and forms a vasculosyncytial membrane. Our aim was to determine whether ABO compatibility puts the fetus at a greater risk of severe fetomaternal hemorrhage. Case study. A tertiary care center. Sample and methods. Between 2003 and 2007, we evaluated eight cases of severe fetomaternal transfusion. The Kleihauer-Betke test was used for diagnosis of fetomaternal hemorrhage. We evaluated blood group compatibility between the mother and fetus and assessed the perinatal outcome. The Fischer's factorial test was used for testing a hypothesis. The incidence of adverse outcomes following transplacental hemorrhage was 75% (six of eight). There were two perinatal deaths and four infants were affected by post-hypoxic damage of varying severity. Fetomaternal ABO compatibility was present in seven of the eight cases. The risk of severe fetomaternal hemorrhage was significantly increased when there was ABO compatibility between the mother and fetus. This was associated with a very poor perinatal outcome. We recommend that resuscitation in utero by intrauterine transfusion should be considered before the 33rd week of gestation in cases of severe fetal anemia. In later gestation, urgent cesarean section is required with adequate resuscitation of the newborn.

A combined flow cytometry–based method for fetomaternal hemorrhage and maternal D

The fetomaternal bleed assay by flow cytometry is a semiquantitative test used to determine the volume of fetomaternal hemorrhage (FMH). We have enhanced this method by combining the fetomaternal bleed assay with a D antibody in the same tube to determine the maternal D as well as the need for Rh immune globulin (RhIG) administration. The performance of the FMB/D assay was compared against the Kleihauer-Betke (KB) acid elution method for the quantitation of fetal bleed and tube method for the maternal D determination. Peripheral blood cells from the pregnant women were fixed and permeabilized, incubated with monoclonal antibodies directed against fetal hemoglobin (Hb F) and D, and analyzed by flow cytometry. The relative concentration of Hb F-containing cells to adult cells was used to determine the volume of the FMH. In addition, the cells were identified as D+ or D-. D typing of nonpregnant adult donors matched in all cases with the tube method with a mean value of 0.01% Hb F-positive cells (n = 25). D typing of pregnant or postpartum samples matched in all cases (n = 100), and the RhIG dose calculated by the percentage of Hb F for each method matched 97 percent (n = 36; p = 0.324). The one discrepant sample was consistent with the acknowledged overestimation when using the KB method. The highly precise anti-Hb F flow cytometric method was combined with maternal D determination by anti-D. This method correlates well with standard assays eliminating the need for additional testing without sacrificing clinical information.

Transplantation of BMSCs expressing hPDGF-A/hBD2 promotes wound healing in rats with combined radiation-wound injury

The aim of this study was to test the efficacy of transplantation of bone marrow-derived mesenchymal stem cells (BMSCs) expressing human platelet-derived growth factor A (hPDGF-A) and human beta-defensin2 (hBD2) in accelerating wound healing of combined radiation-wound injury. Recombinant adenovirus vector simultaneously expressing hPDGF-A and hBD2 was constructed and packaged into virus particles that were used to infect rat BMSCs. The expressions of the exogenous in BMSCs were determined by reverse transcriptase (RT)-PCR and western -blot, whereas the functions were determined by cell counting kit (CCK), wound-healing assay on monolayer cells and Kleihauer-Betke (K-B) test. The recombinant adenovirus-infected BMSCs (1 x 10(7)) were subcutaneously transplanted into the wound bed and wound healing was observed for the indicated duration. Rats with combined total body ionizing radiation (6 Gy) and full-thickness skin excision (2% of total body surface area) wound injury were treated with normal BMSCs (group N), BMSCs infected with recombinant adenovirus expressing hPDGF-A and hBD2 (group T) or phosphate-buffered saline (PBS) (group S). The mean wound healing time, percentage of residual wound area (n=8), blind pathological observation (n=3 per time point for each group) and the amount of bacteria under the scar (the same sample was used in the pathological study, n=3) were used for evaluating wound healing. Collagen was visualized by Sirius red staining. Exogenous hPDGF-A and hBD2 were expressed in BMSCs as indicated by RT-PCR and western blot. Faster wound healing of scratched monolayer cells was demonstrated in hPDGF-A/hBD2 gene-modified BMSCs (T-MSCs) when compared with the corresponding control (P<0.01), and conditioned culture medium from T-MSCs showed stimulative effect on BMSC proliferation and in vitro antibiotic effect in the presence of trypsin. Neutralizing antibody interfering in vitro demonstrated that secreted hPDGF-A was the main factor stimulating cell proliferation. In an in vivo test, the radiation-wound combined injury exhibited shorter healing time (21 days). Histologically, there was better granulation formation/maturation and skin-dependent regeneration, as well as more collagen deposition (P<0.01) in rats of group T than in other groups. The deposition and remodeling of collagen in wounds were ranked in the following order: group T>group N>group S. Significantly less bacterial colony formation in the cultured under-scar samples in the rats of group T was observed (P<0.01) at day 7 and thereafter when compared with control. After transplantation, the BMSCs expressed exogenous genes in the wound for at least 2 weeks, as indicated by the reporter gene. Topical transplantation of gene-modified BMSCs promoted wound healing, which may be the benefit of the secretion of antibacterial hBD2 and mitogenic hPDGF-A, resulting in better granulation formation/maturation and skin appendage regeneration in wound. These data demonstrated the potential application of this combination of cell therapy and gene therapy on refractory wound healing.

Fetomaternal Hemorrhage During External Cephalic Version

To estimate the frequency and volume of fetomaternal hemorrhage during external cephalic version for term breech singleton fetuses and to identify risk factors involved with this complication. A prospective observational study was performed including all patients undergoing a trial of external cephalic version for a breech presentation of at least 36 weeks of gestation between 1987 and 2001 in our center. A search for fetal erythrocytes using the standard Kleihauer-Betke test was obtained before and after each external cephalic version. The frequency and volume of fetomaternal hemorrhage were calculated. Putative risk factors for fetomaternal hemorrhage were evaluated by chi(2) test and Mann-Whitney U test. A Kleihauer-Betke test result was available before and after 1,311 trials of external cephalic version. The Kleihauer-Betke test was positive in 67 (5.1%) before the procedure. Of the 1,244 women with a negative Kleihauer-Betke test before external cephalic version, 30 (2.4%) had a positive Kleihauer-Betke test after the procedure. Ten (0.8%) had an estimated fetomaternal hemorrhage greater than 1 mL, and one (0.08%) had an estimated fetomaternal hemorrhage greater than 30 mL. The risk of fetomaternal hemorrhage was not influenced by parity, gestational age, body mass index, number of attempts at version, placental location, or amniotic fluid index. The risk of detectable fetomaternal hemorrhage during external cephalic version was 2.4%, with fetomaternal hemorrhage more than 30 mL in less than 0.1% of cases. These data suggest that the performance of a Kleihauer-Betke test is unwarranted in uneventful external cephalic version and that in Rh-negative women, no further Rh immune globulin is necessary other than the routine 300-microgram dose at 28 weeks of gestation and postpartum. II.

Minor trauma in pregnancy—is the evaluation unwarranted?

The purpose of this study was to examine the rate of and risks for abruption and adverse pregnancy outcome after minor trauma in pregnancy. This is a 3-year prospective cohort study of patients after noncatastrophic trauma. Data collected included maternal demographics and history, trauma mechanism, and pregnancy outcome. Examination, lab tests including Kleihauer-Betke (KB), and a minimum of 4 hours of fetal monitoring were performed. The primary outcomes were placental abruption and a composite pregnancy morbidity outcome. Univariate and bivariate analysis were performed. Of the 317 patients evaluated for minor trauma, 9 had a positive KB test (2.8%). Delivery information was available on 256 (81%) patients, and there was 1 placental abruption. The 49 cases (19.4%) of composite outcome could not be predicted. Perhaps it is time to reevaluate the extensive evaluations often done after minor trauma in pregnancy, particularly because none of the commonly used objective measures are predictive of adverse outcomes.

Hb Montreal II: A Novel Elongated β-Globin Variant Caused by a Frameshift Mutation [β142 (−C)

We report a novel elongated C-terminal β hemoglobin (Hb) variant caused by a single nucleotide (C) deletion at codon 143 (nucleotide 480 of GenBank entry NM_000518). This deletion leads to the substitution of histidine 143 by threonine, and displaces the β Hb gene stop codon from codon 147 to codon 157. It was identified in a 30-year-old man from Montreal, and called Hb Montreal II. This Hb variant differs from its normal counterpart by 14 residues, the latter 10 being identical to those observed in Hbs Tak, Cranston, Saverne, Trento, and Florida. The patient did not present thalassemic features but had a compensated chronic hemolysis with splenomegaly, red cell inclusion bodies, and a positive Kleihauer test.

A rapid gel agglutination test for the determination of fetomaternal haemorrhage

Determination of fetomaternal haemorrhage (FMH) remains an area of difficulty. In most cases, prophylactic Rh immunoglobulin is usually administered to affected women without testing for foetal red blood cells (RBC). Here, we describe a new particle gel immunoassay (PaGIA) for the determination FMH (FMH-PaGIA). Superparamagnetic particles were coated with monoclonal anti-D and mixed with ethylenediaminetetraacetic acid-anticoagulated blood samples from D-negative pregnant women. The particles were isolated using a magnetic particle concentrator and then placed into the reaction chamber of a gel card. Agglutinated particles on top or dispersed through the gel matrix indicated the presence of D-positive cells. After the test was adapted to detect >or=0.3% D-positive RBC, randomly selected postpartum samples from 208 women were analysed in parallel with the Kleihauer-Betke test (KBT). In addition, all discrepancies were further analysed by flow cytometry. A total of 203 of the 208 postpartum samples were negative in both tests. One sample reacted positive with both assays. Two samples were strongly positive in the new FMH-PaGIA, but negative in the KBT. A serological re-examination revealed that both women were D positive. The KBT gave a false-positive result in two cases because of hereditary persistence of haemoglobin F. The new test is specific, easy to perform and can be done at any time in all laboratories.

Assessment of Fetomaternal Hemorrhage by Flow Cytometry and Kleihauer-Betke Test in Rh-Negative Pregnancies

Objectives: To assess the efficacy of flow cytometry (FC) in the detection and quantification of fetomaternal hemorrhage (FMH) in comparison to the Kleihauer-Betke test (KBT). Methods: 25 unsensitized Rh-negative mothers who had delivered Rh-positive infants were included. Presence of FMH was determined by KBT and FC using FITC-labeled BRAD-3 antibodies. Results: FMH was detected in 19 (76%) patients by FC and 23 (92%) patients by KBT prior to delivery, and in 21 (84%) patients by FC and 23 (92%) patients by KBT after delivery. The mean volume of FMH in the post-delivery samples by KBT and FC were 0.34 ± 0.26 ml (range 0.05–1.2 ml) and 0.37 ± 0.57 ml (range 0.02–2.6 ml) respectively. The volume of post-delivery FMH estimated by KBT and FC correlated well (r = 0.75; ICC α = 0.73). A higher agreement between KBT and FC was seen in the 0.1–0.5 ml range (ĸ = 0.65; p < 0.01). Conclusions: Both manual KBT and FC using FITC-BRAD-3 antibodies show good sensitivity in detecting and quantifying fetal red cells. There is a good correlation between the methods in the 0.1- to 0.5-ml range of FMH.

Placental Drainage of Fetal Blood at Cesarean Delivery and Feto–Maternal Transfusion

To assess the efficacy of placental drainage of fetal blood at the time of cesarean delivery on the incidence of feto-maternal transfusion. This randomized trial includes 86 gravid women who underwent cesarean delivery. Forty-four women were assigned to the placental drainage group and 42 to the no-drainage group. Placental drainage was accomplished by cutting and milking the umbilical cord until no further blood flow occurred. All placentas were spontaneously expelled. The primary outcome variable, as assessed by preoperative and postoperative Kleihauer-Betke tests, was the amount of fetal blood (greater than or equal to 0.5 mL) in the maternal circulation. The group having placental drainage of fetal blood before placental delivery showed a significantly lower incidence (3 of 44, 6.8%) of feto-maternal transfusion (P=.003) as compared with the undrained group (14 of 42, 33%; relative risk 0.20, 95% confidence interval 0.065-0.65; number needed to treat=4). Placental drainage of fetal blood before spontaneous placental delivery at the time of cesarean delivery significantly reduces the incidence of feto-maternal transfusion. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00470899 I.

Long-Term Prognosis for Infants After Massive Fetomaternal Hemorrhage

To evaluate the fetal, neonatal, and long-term prognosis of massive fetomaternal hemorrhage (20 mL or more). This series includes all patients with Kleihauer test values of 40 per 10,000 or higher over an 8-year period at two university hospitals. We examined obstetric, neonatal, and subsequent outcome data for the children. During the study period, 48 patients had massive fetomaternal hemorrhage (crude incidence 1.1 per 1,000; corrected incidence for Rh-negative women 4.6 per 1,000). Six fetal deaths were observed, representing 1.6% of all fetal deaths during the period. Nine newborns (18.7%) were transferred to neonatal intensive care unit (NICU) and five (10.4%) had transfusions. Fetomaternal hemorrhages of 20 mL/kg or more significantly increased the risk of fetal death, induced preterm delivery, transfer to NICU, and neonatal anemia requiring transfusion. Long-term follow-up was not associated with neurological sequelae (0%, 95% confidence interval 0.0-11.6%). When the transfused volume equals or exceeds 20 mL/kg, massive fetomaternal hemorrhage may lead to severe prenatal or neonatal complications. III.

Identification and quantification of fetal red blood cells in maternal blood by a dual‐color flow cytometric method: evaluation of the Fetal Cell Count kit

As an alternative to the cumbersome Kleihauer-Betke test (KBT), flow cytometry represents a powerful method for the identification and quantification of fetal red blood cells (RBCs) in maternal circulation. The aim of this study was to evaluate the Fetal Cell Count kit (IQ Products), an innovative flow cytometric method, based on the combination of antibodies directed, respectively, against fetal hemoglobin (HbF) and carbonic anhydrase (CA), a marker expressed after birth, to discriminate fetal RBCs from adult F cells containing HbF. The investigation was performed by two French laboratories that compared the data obtained by flow cytometry and KBT in 455 pregnant or just-delivered women as well as in 124 artificial mixtures containing from 0.01 to 5.00 percent cord cells. The FL1/FL2 histogram allowed distinction between fetal RBCs (HbF+, CA-), F cells (HbF+, CA+), and adult RBCs (HbF-, CA+). The limits of detection and quantification were determined at 0.03 and 0.10 percent or 0.02 and 0.05 percent when analyzing 100,000 or 200,000 events, respectively. Linearity was demonstrated between 0.01 and 5.00 percent fetal cells in the mixtures (r = 0.95, p < 0.01). A good correlation between fluorescence-activated cell sorting (FACS) and KBT results was obtained with artificial mixtures (r = 0.94, p < 0.01). From the 405 Kleihauer-negative samples, none were identified as positive by FACS. Among the 50 Kleihauer-positive samples, 6 were shown not to contain fetal cells but F cells by FACS. With this new dual-color flow cytometric method, accurate evaluation of fetomaternal hemorrhage was achieved even in the face of HbF of maternal origin.

Evaluation of F cells in sickle cell disorders by flow cytometry – comparison with the Kleihauer–Betke's slide method

Adult F cell numbers are raised in inherited haemoglobin disorders, such as beta-thalassaemia and sickle cell anaemia, hereditary persistence of foetal haemoglobin, and some acquired conditions, such as juvenile myelomonocytic leukaemia, during acute erythropoietic stress and pregnancy. True foetal erythrocytes containing foetal amounts of HbF can also occur in the adult circulation during the leakage of HbF-containing cells from the foetus to the maternal circulation. In normal adults, HbF is restricted to a small proportion (3-7%) of red blood cells (RBC), termed 'F cells'. Techniques estimating the amount of HbF use lysates prepared from RBC, whereas those that estimate the adult F cell count use intact RBC. An accurate assessment of adult F cells in sickle cell disorders is important because increased adult F cells are associated with decreased morbidity in these disorders. In the present study, HbF levels were measured and adult F cell numbers were estimated in 100 blood samples (25 normal individuals, 25 sickle heterozygotes, 25 sickle homozygotes and 25 sickle beta-thalassaemia cases), using high pressure liquid chromatography for HbF levels, and flow cytometry and the Kleihauer-Betke (KB) acid elution microscope slide method for cell counts. Flow cytometry gave a more accurate assessment of adult F cells, eliminating any manual error, as compared to KB, which was less sensitive and precise as it is based on subjective visual interpretation.

Detection of fetal nucleated red blood cells in the maternal circulation by Kleihauer test

Maternal blood was obtained from 18 pregnant women at 7 to 25 weeks of gestation. After Percoll discontinuous density gradient centifugation, the fetal nucleated red blood cells (NRBCs) were stained with Kleihauer test. Positive fetal cells appeared with an intense red cytoplasmic staining while maternal cells with adult haemoglobin were colourless. Individual positive NRBC was collected by micromanipulator and whole genome amplification was then performed to determine sex and STR status. This allowed the simultaneous verification of the fetal origin of NRBC and prenatal diagnosis of genetic diseases. The non-invasive prenatal genetic diagnosis of 9 fetuses at high risk of Duchenne muscular dystrophy (DMD) was completed successfully. The Kleihauer test is a rapid, simple and direct chemical staining method to select fetal cells and can be applied in prenatal diagnosis.

A survey of the current use of anti-D immunoprophylaxis and the incidence of haemolytic disease of the newborn in Italy.

The Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) carried out a survey on the current use of anti-D immunoprophylaxis (IP) in Italy, on its ways of use and on the impact that it has had on decreasing haemolytic disease of the newborn (HDN), due to maternal-foetal incompatibility for the D antigen. The survey was carried out using a questionnaire prepared by the Working Group established for this purpose by the SIMTI. The questions were divided into five groups: the ways of carrying out IP, evaluation of foetal-maternal haemorrhage, serological tests after IP, the current incidence of HDN, and data on exchange transfusions. Data were obtained from 69 Transfusion Services (TS). Four of these give IP antenatally, whereas in the remaining cases IP is given after birth. Almost all the TS evaluate the amount of foetal-maternal haemorrhage in order to give additional doses of anti-D IgG, with the most widely used method being the Kleihauer-Betke test. Data were collected from 176,010 pregnancies: 18,639 were D-negative women, of whom 18,440 were not immunised. There were 136 cases of HDN with anti-D antibodies, and 39 of these required exchange transfusions (ET). Furthermore, there were 1,535 pregnant women with anti-A and/or anti-B IgG, which were clinically significant in 83 and required ET in 37. Finally, 40 women had antibodies, directly related to the pregnancy, against antigens other than D (in eight of these cases ET was necessary). The survey carried out by SIMTI was able to give a sufficiently full and accurate picture of current Italian practices concerning the use and ways of use of anti-D IP in pregnancy and the puerperum, as well as the incidence and characteristics of HDN. Furthermore, this survey was the basis for guidelines on the management of HDN, produced by SIMTI in collaboration with the Italian Society of Obstetricians and Gynaecologists.

Detection of fetomaternal hemorrhage following chorionic villus sampling by Kleihauer Betke test and rise in maternal serum alpha feto protein

To assess incidence and volume of fetomaternal hemorrhage (FMH) after chorionic villus sampling (CVS) by Kleihauer Betke test (KBT) and rise in maternal protein (MSAFP). A prospective study was conducted on 61 cases requiring CVS. FMH due to CVS was assessed by KBT and MSAFP. Out of 61 cases, 60 (98.36%) cases showed FMH by MSAFP while all showed FMH by KBT. Median volume of FMH detected by MSAFP was 0.06 mL (25 to 75th interquartile (IQR) 0.01 to 0.12 mL) and by KBT was 0.45 mL (25 to 75th IQR 0.09 to 0.90). Mean volume of FMH detected by MSAFP was 0.1 + 0.1424 mL and by KBT was 0.58 + 0.637 mL. Significant FMH up to 0.1 mL was found in 20 (32.8%) and 45 (60.6%) by MSAFP and KBT respectively. MSAFP and KBT are sensitive to detect FMH. KBT estimates more FMH than MSAFP. Fifty micrograms of anti-D is sufficient to cover FMH during CVS.

Traumatisme au cours de la grossesse : pertinence des éléments de surveillance dans l’évaluation des suites obstétricales

The objective of this study is to evaluate current means of monitoring of pregnant women victims of abdominal trauma and to determine whether systematic hospitalization is warranted. and methods. This was a retrospective study of pregnant women who consulted the Nantes hospital during a three-year period for abdominal trauma during pregnancy. Four principal means of monitoring (examination, fetal heart rate or ERCF, ulstrasonography, Kleihauer test) were evaluated according to the fetal outcomes. Ninety-five patients were including in the study. The abdominal trauma resulted from a traffic accident for 49 patients (51%), a fall for 39 patients (41%) and high-energy trauma for 7 patients (8%). Three patients (3%) presented fetal complications: one fetal death, one fetal porencephaly, one premature birth at 34 weeks gestation for premature rupture of the membranes and abruptio placentae. These three women were traffic accident victims who also suffered extra-abdominal trauma. Ultrasonographic signs (npv=99%) and anomalies foetal monitoring (npv=98%) were also observed in two cases (fetal death and premature birth). The porencephaly was fortuitously discovered 3 weeks after trauma at a routine ultrasound. The Kleihauer test remained negative in all patients. The other traumas did not give lead to fetal complications. The incidence of premature births did not increase after trauma. Fetal outcome was good when monitoring parameters were normal at admission. Ultrasonography and fetal heart rate monitoring enable proper assessment of fetal well-being but only have predictive value if they are negative. A negative Kleihauer test, useful for Rh negative patients to determine the amount of anti-D antibody to inject, does not provide any information about fetal outcome when it is negative. The complications observed were related only to traffic accidents. Hospitalization is probably not very useful when monitoring elements are normal at admission and when the women has suffered mild trauma.