Clinical high-risk designation does not predict excess fetal-maternal hemorrhage

Paul M Ness; Michael L Baldwin; Jennifer R. Niebyl

doi:10.1016/0002-9378(87)90228-6

Back

Clinical high-risk designation does not predict excess fetal-maternal hemorrhage

Journal article

Peer reviewed

Clinical high-risk designation does not predict excess fetal-maternal hemorrhage

Paul M Ness, Michael L Baldwin and Jennifer R. Niebyl

American Journal of Obstetrics and Gynecology, Vol.156(1), pp.154-158

01/01/1987

DOI: 10.1016/0002-9378(87)90228-6

PMID: 3026183

View Online

Abstract

During a 5-year period, an enzyme-linked antiglobulin test was used to screen and quantitate fetal-maternal hemorrhage in 789 consecutive D-negative mothers who were delivered of D-positive babies. Six hundred seventy-two patients (85.2%) had no detectable fetal-maternal hemorrhage, and 117 patients (14.8%) had a detectable fetal-maternal hemorrhage. Eight of the 789 (1%) had a fetal-maternal hemorrhage greater than 30 ml and required more than one vial of Rh immune globulin. Two patients with fetal-maternal hemorrhage of 29 and 30 ml also received additional Rh immune globulin. Each case was reviewed for the presence of high-risk features that are thought to predict patients at risk for fetal-maternal hemorrhage. Patients having a cesarean section or complicated vaginal delivery were considered to be in a group at high risk for fetal-maternal hemorrhage, while those with a spontaneous vaginal delivery were considered not to be at risk for fetal-maternal hemorrhage. Thirty-two of 237 patients (13.5%) in the risk group and 82 of 552 patients (15.3%) in the group not at risk had detectable fetal-maternal hemorrhage. The incidence of fetal-maternal hemorrhage for these two groups was not statistically different (p greater than 0.50 by chi 2 analysis). If only patients in the risk group had been screened for fetal-maternal hemorrhage, then five of 10 (50%) who required more than one vial of Rh immune globulin would have been undertreated and at risk for developing anti-D antibodies. In addition, newborn birth weight, Apgar scores, and hematocrits were examined for 13 cases of fetal-maternal hemorrhage of greater than or equal to 21 ml, and none of these characteristics could be used to predict patients at risk for fetal-maternal hemorrhage. Therefore, no maternal or newborn characteristics could be identified that would reliably predict patients at risk for fetal-maternal hemorrhage. We conclude that all D-negative patients with D-positive babies should continue to be screened for fetal-maternal hemorrhage to identify those patients requiring more than one vial of Rh immune globulin.</p>

Pregnancy

Obstetrics and Gynecology

Delivery

Obstetric/methods

Female

Fetomaternal Transfusion/diagnosis

Humans

Immunoenzyme Techniques

Immunoglobulins/administration & dosage

Infant

Newborn

Prospective Studies

Rh Isoimmunization/prevention & control

Rh-Hr Blood-Group System/immunology

Rho(D) Immune Globulin

Risk

Details

Title: Subtitle: Clinical high-risk designation does not predict excess fetal-maternal hemorrhage
Creators: Paul M Ness
Michael L Baldwin
Jennifer R. Niebyl - University of Iowa
Resource Type: Journal article
Publication Details: American Journal of Obstetrics and Gynecology, Vol.156(1), pp.154-158
DOI: 10.1016/0002-9378(87)90228-6
PMID: 3026183
NLM abbreviation: Am J Obstet Gynecol
ISSN: 0002-9378
Language: English
Date published: 01/01/1987
Academic Unit: Obstetrics and Gynecology
Record Identifier: 9983557415202771

Metrics

20 Record Views

38 Times Cited - Web of Science