Assessment Of Feto Maternal Hemorrhage In Antenatal Period In Indian Females – Need Of Modifications In Anti D Prophylaxis In India.
Assessment Of Feto Maternal Hemorrhage In Antenatal Period
DOI:
https://doi.org/10.70284/njirm.v3i3.2048Keywords:
Andhra Pradesh , Bacteriological Profile , Antibiotic Resistance , Septicaemia , Blood cultureAbstract
Objective: -To assess Feto maternal Hemorrhage in pregnant Indian Females. Method: - 516 consecutive antenatal patients attending the Fetal Medicine Department of Vadilal Sarabhai General hospital under NHL Municipal Medical College, Ellis Bridge, Ahmadabad were analyzed for Feto maternal Hemorrhage by Kleihauer Betke test after taking informed consent. Result: - All the 516 antenatal patients including those who underwent invasive procedures like Chorionic villus sampling, Amniocentesis, Amnioinfusion and Intrauterine blood transfusion had Feto maternal Hemorrhage less than 2 ml. Conclusion: - Study shows that Feto maternal hemorrhage in Indian women is very insignificant even after invasive procedures. Feto maternal Hemorrhage has special importance in Rh Negative Women, carrying an Rh positive fetus.FMH can lead to isoimmunization leading to a wide spectrum of antenatal and postnatal fetal complications ranging from anemia to stillbirth. Answer to this is Antenatal Anti –D prophylaxis which is not a standard practice in our setup due to high cost of Anti D. As we have found FMH to be less than 2 ml even a dose of 50 microgram can suffice if given at 26 and 32 weeks of gestation to prevent isoimmunization thus reducing the cost and encouraging the practice of Antenatal Anti D prophylaxis.
References
2. Feto maternal hemorrhage during Antenatal Study – Indian study The incidence of Large Feto maternal Hemorrhage and KBT; Raed Salim, MD. Izhar Ben Shlomo MD.
3. Feto maternal hemorrhage: Treatment by Intrauterine Transfusion; Michael Permezel, MD, Lachlan DE Crespigny MD, Peter England MBBS.4. Assessment of FMH by Flow Cytometry and KBT in RH negative Pregnancies (Gynecol Obste. Invest 2008 ; 65 : 84- 88)
5. The Kleihauer Test; Section B: Clinical guideline King Edward Memorial Hospital Perth, Western Australia. Prenatal Rh – immunoprophylaxis with 300 micrograms immunoglobulin Anti d in the 28th week of Pregnancy; Acta Obste. Gynecol Scand .1989; 68 (1) : 45-7
6. Feto maternal transfusion after chorionic villus sampling: clinical implications. Human Reproduction. Vol 1. No. 1 pp 37-40; 1986
7. Gel technology: An easy and useful method for estimating Feto maternal hemorrhage in the Blood Banks of Developing Nations. Laboratory Medicine 2010 ; 41 (3) : 147 -149
8. Routine antenatal anti D prophylaxis for women who are Rhesus negative. Review of NICE, technology appraisal guidance 41 . Issue date August 2008.
9. Recommendations for the use of Anti D immunoglobulin for Rh prophylaxis. Transfusion Medicine. 1999; 9: 93-7.
10. Pregnancy in the Rh negative Woman. Author Rehana kausar Vol 1,no.4 (2005-01 – 2005-02)
11. Antenatal prophylaxis of RH Immunization with 250 mcg anti D immunoglobulin. Acta Obste Gynec Scandinavia , Vol 63 :1984 :115
12. Rhesus gam im ( solution for intramuscular Injection) Commercial Anti D reagents in Indian market & detection of partial D variants. Indian J Med Res 125, May 2007, pp615-617
13. Feto maternal Hemorrhage. Obste. Gynecol 2010 May; 115 (5) : 1039-51
14. Blood group Systems Prevention of Rh D alloimmunisation in Rh D negative women. Czech republic .2010 Mar ; 154 (1) 3-7
15. Rhoclone ( Anti – rho (D) immunoglobulin (monoclonal ) 300mcg /150mcg, Feto maternal Hemorrhage detection .Authors Jenny Bryant, ARCBS, Sydney, Peter Hobson, Sullivan Nicolaides Pathology, Margaret Nelson, Hematology Dept. Royal Prince Alfred Hospital, Sydney.
16. Anti D administration in early pregnancy – A time for a new protocol. Aust. N Z J Obste. Gynecol. 1996 May; 36 (2): 227-8.
17. Measurement of FMH: A comparative study of three Kleihauer techniques and two Flow cytometry methods. National blood `service, Mersey and North Wales, Liverpool, UK.
18. Detection of fetal red cells in Feto maternal hemorrhage using a fetal hemoglobin monoclonal antibody by flow cytometry.
