Assessment of fetomaternal hemorrhage among rhesus d. Minor haemorrhage blood loss less than 50 ml that has settled major haemorrhage blood loss of 50 ml, with no signs of clinical shock massive haemorrhage blood loss greater than ml andor signs of clinical shock. Post fetal death in utero fdiu when fetal blood group is unknown. Advances in obstetric care enable the clinicians to diagnose, anticipate, prevent and treat severe cases of antepartum haemorrhage in most patients. Kleihauerbetke test can distinguish fetal from maternal red blood cells. The apt test is most commonly used in cases of vaginal bleeding late during pregnancy antepartum haemorrhage to determine if the bleeding is from the mother or the fetus. Antepartum hemorrhage a 30 year old g2p1 with previous spontaneus vaginal delivery and appropriately grown fetus is admitted at term with fresh vaginal bleeding and abdominal pain.
Differentiate the clinical features of placenta previa, abruptio placenta and other possible causes. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester. None of the women had abdominal pain or vaginal bleeding. It is associated with significant maternal and fetal morbidity and mortality. It is recommended that wherever possible a transplacental haemorrhage of greater than 4 ml should be confirmed by flow cytometric analysis. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour.
Kleihauer betke test findings may help to determine the appropriate dosage of rh o d immune globulin in cases of significant fetalmaternal hemorrhage. The kleihauer test the kleihauer test is performed on a maternal sample. Betke test for fetal rbc quantification 12, it is not without its limitations. The kleihauerbetke kb test, kleihauer test, is a blood test used to. In this article, we shall look at the pathophysiology, clinical features and management of placenta praevia. There is no consensus among obstetricians regarding the optimum management of reduced foetal movements. Recurrent aph is the term used when there are episodes of aph on more than one occasion. The kleihauer betke kb test, kleihauer betke kb stain, kleihauer test or acid elution test, is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mothers bloodstream. Feto maternal haemorrhage, transplacental haemorrhage, kleihauer, kleihauer betke, haemolytic disease of the fetus and newborn, antid immunoglobulin, flow cytometry, acid elution. Charbit et al reported a 100% positive predictive value for fibrinogen levels equal to or less than 200 mgdl in detecting severe postpartum haemorrhage, whereas levels greater than or equal to 400 mgdl have a 79% negative predictive value. Definition antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term. Fibrinogen, kleihauer if rh negative, group and x match minimum 4 units. Antepartum haemorrhage placenta childbirth free 30.
Antepartum hemorrhage antepartum hemorrhage definition vaginal bleeding after 20 wks gestation. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Fetomaternal hemorrhage was absent according to all 3 methods in patients. Detection of fetomaternal hemorrhage kim 2012 american. Fetoprotein afp concentration and kleihauer staining of maternal blood, taken both before and after the procedure, revealed increases in afp values of more than 40 per cent in 30 per cent of the patients examined. Comparison of estimation of volume of fetomaternal hemorrhage using kleihauer betke test and microcolumn gel method in dnegative nonisoimmunized mothers. The most common investigations performed are cardiotocography ctg, ultrasound scan uss and umbilical artery doppler. Kleihauer test is recommended in rhnegative mothers. Manual removal of placenta after a previous pregnancy. Used to determine the required dose of rh immune globulin.
The rcog guideline recommends that all patients with aph should have a full blood count fbc and a group and save. Some form of dic is present in up to 20% of patients with severe abruptions. Fetomaternal haemorrhage fmh was studied after 46 cordocenteses. Because it can lead to death of the mother and fetus, the pregnant sufferer must be admitted to hospital for proper assessment. Clinical use of the kleihauer betke test clinical use of the kleihauer betke test holcomb, william l gunderson, erik. A kleihauer test should not be requested in the setting of an antepartum haemorrhage in order to diagnose abruption. Antepartum haemorrhage assessment hx examination vitals general abdominal exam avoid pvspec until placenta praevia excluded investigations mum. Rare causes include vasa previa and uterine rupture. Hospital based crosssectional study was conducted among 75 rhd negative pregnant mothers using. Post amniocentesis, amnioreduction, insertion of fetal amniotic shunts. Request pdf antepartum haemorrhage the incidence of antepartum haemorrhage aph is reported as 3. Antepartum haemorrhage or bleeding in the second half of. A kleihauer betke test should be considered in all trauma patients because it may be an indicator of the severity of uterineplacental trauma and those that are at risk for preterm labor muench.
Use of aspirin before 16 weeks of pregnancy to prevent preeclampsia also appears effective at preventing. Fetomaternal haemorrhage lead to severe rh sensitization in rh negative mother a kleihauer betke or similar test is essential 1. A kleihauer must be taken within 2 hours of an antenatal sensitising event andor birth. The most common investigations performed are cardiotocography ctg, ultrasound scan uss and. This study aimed to assess fetomaternal hemorrhage fmh among rhd negative pregnant mothers using two techniques, kleihauer betke kbt and flow cytometry fcm. A negative kleihauer test indicates that one dose of rhdig is sufficient. It is used to assess the volume of a fetomaternal haemorrhage fmh and determine if additional doses of rhdig are required. Antepartum haemorrhage is a relatively common entity with potentially serious implications for the mother and the fetus. Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops. What is the role of a kleihauerbetke test in the workup. Although the kleihauer betke test is inexpensive and requires no special equipment, it lacks standardization and precision, and may not be accurate in conditions with elevated fcells. If there are signs of fetal or maternal compromise, consider immediate delivery. Aph complicates 35% of pregnancies and is a leading cause of.
A positive test would indicate that blood is of fetal origin, and could be due to vasa previa. Ectopic pregnancy and miscarriage cg154 published date. A kleihauer test may also help to establish the type of antepartum haemorrhage which has occurred, by determining the presence or absence of a fetomaternal. The writing group produced the draft guideline which was subsequently revised by. Placenta praevia causes clinical features management. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Antepartum haemorrhage definition bleeding from the vagina any time after 24 weeks gestation until the birth of the baby blood loss greater than 300mls or any amount causing hypovolaemic shock incidence 35% of all pregnancies. For antepartum kleihauer tests, the result may stay positive in cases where the fetus is rhd negative even though one or more doses of rhdig have been given. Hospital based crosssectional study was conducted among 75 rhd negative pregnant mothers using convenient. On examination she is distressed with pain, pale, her pulse is 100 bpm, blood pressure 11080 mmhg, and she has a tender uterus contracting 310minutes. The kleihauer test and fetomaternal haemorrhage birth.
A standard blood smear is prepared from the mothers blood, and exposed to an acid bath. Results for kleihauer test 1 10 of 21 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download export csv export ris 10 per page 50 per page 100 per page 250 per page. It takes advantage of the differential resistance of foetal hemoglobin to acid. Antid gamma globulin should be administered to all rhesus negative women, with the dose being determined by a kleihauer test to give an estimate of the size of the feto. Women who present after 24 weeks gestation need not be offered ffdna please follow pathway one appendix one sensitising events antepartum haemorrhage. The kleihauer test is used to identify women with a large fetomaternal haemorrhage 6 ml of packed fetal red cells who may need additional doses of rhd immunoglobulin rhdig to ensure clearance of all fetal red cells. To determine if patientspecific doses of prophylactic antid warrant further investigation in ethiopia and wider africa. Mar 11, 2016 antepartum haemorrhage aph is usually defined as bleeding from the birth canal after the 24th week of pregnancy. Kleihauer betke test is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to the mothers bloodstream.
Antihbf flow cytometry is a promising alternative, although its use is limited by equipment and staffing costs. This includes midwifery, obstetric, anaesthetic, imaging. Management of aph in general there are few high quality clinical trials to guide the management of antepartum haemorrhage or abruption, where there is high quality evidence this is noted below. Detection of fetomaternal haemorrhage associated with. Antepartum haemorrhage aph is bleeding from the genital tract after 20. C ultrasound can be used to diagnose placenta praevia but does not exclude. Kleihauerbetke test is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to the mothers bloodstream. Additional management considerations for major aph kleihauer test should be performed in rhesus dnegative women for administration of antid refer to separate guideline. Antepartum haemorrhage aph complicates 25% of pregnancies and is defined in some literature as any bleeding from the genital tract after the 20 th week of pregnancy and before labour. Blood films were fixed in 80% ethanol and slides were then allowed to stand at 37oc in a citric phosphate buffer for 5 min. Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 20th to 24th week of pregnancy up to delivery.
Role of kleihauer test in detection of fetomaternal. A kleihauer test is also necessary for all rhesus negative women. If a woman presents more than 2 hours following a sensitising event a kleihauer must still be taken. The most important causes of aph are placenta praevia and placental abruption, although these are not the most common. Fibrinogen levels rise in pregnancy so normal or low levels and prolonged prothrombin time suggest disseminated intravascular. Antepartum haemorrhage aph including placental abruption definition. Antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. If the first ctg shows a sinusoidal pattern a kleihauer test can be requested immediately. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. Antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term.
Antepartum haemorrhage king edward memorial hospital. Antepartum haemorrhage is defined as bleeding from the genital tract after the 20th week of pregnancy and. The original and complete rcog guideline can be found at the below link for your reference. For a full summary of kleihauer indications refer to wnhs transfusion protocols. Antepartum haemorrhage the royal childrens hospital. Evidencebased information on kleihauer test from hundreds of trustworthy sources for health and social care. Obstetric haemorrhage both antepartum and postpartum is one of the leading causes of. The acid elution technique described by kleihauer was used to demonstrate fetal cells. Clinical use of the kleihauerbetke test, journal of. Reduced fetal movements can be the only presenting symptom. Dat direct coombes test a test performed to detect any maternal antibodies that may be attached to the infants rbc. Oct 05, 2016 fetomaternal haemorrhage lead to severe rh sensitization in rh negative mother a kleihauer betke or similar test is essential 1. Bcsh fetomaternal haemorrhage 2009 amended september 2009. Antepartum haemorrhage placenta childbirth free 30day.
Betke test is the most widely used test to quantify the volume of fmh 95% of laboratories participating in the 2009 cap proficiency testing for fetal rbc detection used the kleihauer. It is an important cause of antepartum haemorrhage vaginal bleeding from week 24 of gestation until delivery. Kleihauer betke bedside clot test other investigations di ctated by presence of comorbid conditions e. Antepartum haemorrhage or bleeding in the second half.
Pdf comparison of estimation of volume of fetomaternal. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption. Antepartum haemorrhage aph or prepartum hemorrhage is defined as. Massive fetomaternal haemorrhage fmh of more than 30 ml can cause significant fetal morbidity and mortality.
Avoid vaginal examination until placenta praevia is excluded. Antepartum haemorrhage clinical practice guidelines. If this method is not available then a separate operator should confirm the fmh by the kleihauer technique or if this is not possible, e. C the kleihauer test is not a sensitive test for diagnosing abruption. The kleihauer test is not a sensitive test for diagnosing placental abruption.
Ctg ultrasound mx principles resuscitate call for help. General examination, besides the initial assessment. Antepartum or prepartum haemorrhage is bleeding from the birth canal which occurs after 24 weeks of gestation. Diagnosis antepartum if the placenta is low lying or there is multiple. Antepartum haemorrhage guideline for management 19. Antepartum haemorrhage aph including placental abruption. Antepartum haemorrhage flowchart moet iv access site two largebore size 14 or 16 gauge iv cannulae. May 11, 2017 antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. Do not use a kleihauer test for quantifying fetomaternal haemorrhage. D the kleihauer test should be performed in rhesus d rhdnegative women to quantify fetomaternal haemorrhage fmh in order to gauge the dose of antid immunoglobulin antid ig required.
Antepartum hemorrhage knowledge for medical students and. The kleihauerbetke test is a blood test used to measure the amount of foetal hemoglobin transferred from a foetus to its mothers bloodstream. Bcsh fetomaternal haemorrhage 2009 amended september. It can occur at any time until the second stage of labour is complete. Women who present with major or massive haemorrhage should also have liver and renal function blood tests and a coagulation screen including klauss fibrinogen. A kleihauer test may also help to establish the type of antepartum haemorrhage which has occurred, by determining the presence or absence of a fetomaternal haemorrhage. Placenta praevia is where the placenta is fully or partially attached to the lower uterine segment. This guideline is for the use of all staff involved in the management of women with an antepartum haemorrhage. Describe an appropriate management plan based on the probable cause. Bloods for fbc full blood count, group and antibody screen and kleihauer. Do not use a kleihauer test for quantifying feto maternal.
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