The influence of maternal age, parity, gestational age and birth weight on fetomaternal haemorrhage during spontaneous delivery

Czech version

Authors: M. Studničková ¹; M. Lubušký ^1,2; O. Šimetka ³; M. Pětroš ³; M. Procházka ¹; M. Ordeltová ⁴; K. Vomáčková ⁵; K. Langová ⁶
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ¹; Ústav lékařské genetiky a fetální medicíny LF UP a FN Olomouc, přednosta prof. MUDr. J. Šantavý, CSc. ²; Porodnicko-gynekologická klinika FN Ostrava, přednosta MUDr. O. Šimetka, Ph. D. ³; Ústav imunologie LF UP a FN Olomouc, přednosta prof. MUDr. E. Weigl, CSc. ⁴; 1. chirurgická klinika LF UP a FN Olomouc, přednosta doc. MUDr. Č. Neoral, CSc. ⁵; Ústav lékařské biofyziky LF UP Olomouc, přednostka prof. RNDr. H. Kolářová, CSc. ⁶
Published in: Ceska Gynekol 2012; 77(3): 256-261

Overview

Objective:
Determine the influence of maternal age, parity, gestational age and birth weight on the volume of fetal erythrocytes which enter the maternal circulation during spontaneous delivery. Determining these parameters would enable improving the guidelines for RhD alloimmunization prophylaxis.

Design:
Prospective clinical study.

Setting:
Department of Obstetrics and Gynecology, University Hospital, Olomouc.

Methods:
A total of 2413 examinations were performed. The amount of fetal erythrocytes entering maternal circulation during uncomplicated spontaneous delivery of one fetus was determined by flow cytometry using the BDFACSCanto cytometer (Becton Dickonson International).

Laboratory processing:
Fetal Cell Count kit (Diagnosis of Feto-maternal transfusion by flow cytometry), IQ Products, IQP-379.

Calculation of total volume of fetal erythrocytes entering maternal circulation:
Scientific Subcommittee of the Australian and New Zealand Society of Blood Transfusion. Guidelines for laboratory assessment of fetomaternal haemorrhage. 1^st ed. Sydney: ANZSBT, 2002: 3-12.

Results:
The average maternal age when FMH ≤ 1.8 ml (95 perc) was 29.4 years vs. 29.1 years when FMH > 1.8 ml, median 30 years in both groups, the difference was not statistically significant (p = 0.501).

The average gestational age when FMH ≤ 1.8 ml (95 perc) was 275.3 days vs. 276.9 days when FMH > 1.8 ml, median 278 days (39 weeks +5 days) vs. 276 days (39 weeks + 3 days), the difference was not statistically significant (p = 0.849).

The average birth weight when FMH ≤ 1.8 ml (95 perc) was 3312 g vs. 3353 g when FMH > 1.8 ml, median 3340 g vs. 3330 g, the difference was not statistically significant (p = 0.743).

FMH > 1.
8 ml (5 perc) was present in 4.1% of primiparas (42/1023), in 4.2% of secundiparas (44/1050) and in 5.3% of multiparas (18/340), the difference was not statistically significant (p = 0.607).

The difference in maternal age, parity, gestational age and birth weight were also not statistically significant for fetomaternal hemorrhage FMH > 2.1 ml (2.5 perc), FMH > 2.5 ml (n = 25), FMH > 5 ml (n = 5).

Conclusion:
Maternal age, parity, gestational age and birth weight does not present a risk factor for excessive fetomaternal hemorrhage during spontaneous delivery.

Key words:
fetomaternal haemorrhage, fetomaternal characteristics, spontaneous delivery, anti-D IgG, RhD alloimunization.

Sources

1. Agarwala, P., Sekhar Das, S., Guptab, R., et al. Quantification of Feto-Maternal Hemorrhage: Selection of Techniques for a Resource-Poor Setting. Gynecol Obstet Invest, 2011, 71, p. 47–52.

2. Augustson, BM., Fong, EA., Grey, DE., et al. Postpartum anti-D: can we safely reduce the dose?. MJA, 2006, 184, p. 611–613.

3. Australian & New Zealand Society of Blood Transfusion Inc. Guidelines for laboratory assesment of fetomaternal haemorrhage, 2002, Australia.

4. Crowther, C., Middleton, P. Anti-D administration after childbirth for preventing Rhesus alloimmunisation. The Cochrane Database of Systematic Reviews, 2010.

5. Dziegiel, MH., Nielsen, LK., Berkowicz, A. Detecting fetomaternal hemorrhage by flow cytometry. Curr Opin Hematol, 2006, 13, p. 490–495.

6. Fernandes, BJ., von Dadelszen, P., Fazal, I., et al. Flow cytometric assessment of feto-maternal hemorrhage; a comparison with Betk-Kleihauer. Prenat Diagn, 2007, 27, p. 641–643.

7. Gielezynska, A., Fabijańska-Mitek, J., Debska, M. Calculation of feto-maternal haemorrhage volume using various morphological parameters and various formulas. Pol Merkur Lekarski, 2011, p. 228–230.

8. Lubušký, M. Prevence Rh (D) aloimunizace u Rh (D) negativních žen. Prakt Gyn, 2008, 2, s. 100–103.

9. Lubusky, M. Prevention of RhD alloimmunization in RhD negative women. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2010, 154, p. 3–8.

10. Lubusky, M., Prochazka, M., Simetka, O., Holuskova, I. Guideline for prevention of RhD alloimmunization in RhD negative women. Čes Gynek, 2010, 75, s. 323–324.

11. Moise, Jr JM. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol, 2008, 112, p. 164–176.

12. National Blood Authority. Guidelines on profylactic use of Rh D immunoglobulin (anti-D) in obstetrics, 2003, N. H. M. R. C., Canberra, A. C. T.

13. National Institute for Clinical Excellence. Guidance on the use of routine antenatal anti-D prophylaxis for RhD-negative women, 2002, London.

14. Pelikan, DM., Scherjon, SA., Kanhai, HH. The incidence of large fetomaternal hemorrhage and the Kleihauer-Betke Test. Obstet Gynecol, 2005, 106, p. 642–643.

15. Pelikan, DM., Scherjon, SA., Mesker, WE., et al. Quantification of fetomaternal hemorrhage: A comparative study of the manual and automated microscopic Kleihauer-Betke tests and flow cytometry in clinical symplex. Am J Obstet Gynecol, 2004, 191, p. 551–557.

16. Porra, V., Bernaud, J., Gueret, P., et al. Identification and quantification of fetal red blood cells in maternal blood by a dual-color flow cytometric method: evaluation of Fetal Cell Count kit. Transfusion, 2007, 47, p. 1281–1289.

17. Perslev, A., Jorgensen, FS., Nielsen, LK., et al. Fetomaternal hemorrhage in women undergoing elective cesarean section. Acta Obstet Gynecol Scand, 2011, 90, p. 253–257.

18. příbalový leták Fetal Cell Count Kit, IQ Products.

19. příbalový leták Fetální hemoglobin, Sigma – Aldrich.

20. příbalový leták Rhesonativ, Octa Pharma.

21. Savithrisowmya, S., Singh, M., Kriplani, A., et al. Assessment of fetomaternal hemorrhage by flow cytometry and Kleihauer-Betke Test in Rh-negative pregnancies. Gynecol Obstet Invest, 2008, 65, p. 84–88.

22. Salim, R., Ben-Shlomo, I., Nachum, Z., et al. The incidence of large fetomaternal hemorrhage and the Kleihauer-Betke Test. Obstet Gynecol, 2005, 105, p. 1039–1044.

23. Scientific Subcommittee of the Australian and New Zealand Society of Blood Transfusion. Guidelines for laboratory assessment of fetomaternal haemorrhage. 1st ed. Sydney: ANZSBT, 2002, p. 3–12.

24. Smart, E., Armstrong, B. Oxford: Blackwell Publishing, Blood group systems, ISBT Science Series, 2008, 3, p. 68–92.

25. Studničková, M., Ľubušký, M., Ordeltová, M., Procházka, M. Možnosti stanovení fetomaternální hemoragie. Čes Gynek, 2010, 75(5), s. 443–446.

26. Uriel, M., Subira, D., Plaza, J., et al. Identification of feto-maternal haemorrhage around labour usány flow citometry immunophenotyping. Eur J Obstet Gynecol Reprod Biol, 2010, 151, p. 20–25.

27. Wylie, BJ., D’Alton, ME. Fetomaternal hemorrhagie. Obstet Gynecol, 2010, 115, p. 1039–1051.