Evaluation of fetomaternal hemorrhage after post - abortion therapeutic curettage

Hemolytic diseases in fetus and newborn were known for years; the principle of these pathologies is defined Basically entrance of fetal blood cells to maternal circulation results in these ranges of diseases. Risk factor determination, early diagnosis of F.M H and adequate dosage of Anti - D Ig administration will be attempted to prevent subsequent adverse outcome on fetus and newborn. The quantification of fetal cells in the maternal circulation post - curettage miscarriage remains an important goal to prevent active immunization in mother. In this cross sectional study, during six months, from April 2004, one hundred patients post - abortion therapeutic curettage enrolled, in Ghaem Hospital, Mashhad University. Maternal age, gestational age, maternal blood group and Rh, gravidity, severity of maternal hemorrhage, HcT, BP and duration of vaginal bleeding were recorded. The KB test was done in all patients amount of FIMIH and Rh IgG dosage in positive KB patients were calculated. Data were analyzed with SPSS [Ver. 10] software. The KB test was positive in 35% of the patient. Gestational age, maternal H.ct, pain and severity of hemorrhage had significant relation to K.B test positive. F.M.H was 0.1-5 cc in 17 patients and in 18 it was less. Lower gestational age in abortion time decreases FMH risk the usual Rh - IgG dosage [50 micro gr] sounded to be adequate for Rh Immunization after post - abortion therapeutic curettage

Fetomaternal hemorrhage after midtrimester genetic amniocentesis at King Chulalongkorn Memorial Hospital.

Midtrimester genetic amniocentesis has become an accepted part of modern obstetric care. Although its accuracy is well established, the risk of fetomaternal hemorrhage remains controversial. This prospective study was conducted to determine how effective continuous ultrasound guided amniocentesis is in preventing fetomaternal hemorrhage. The authors investigated 30 patients undergoing midtrimester genetic amniocentesis at our institution. Amniocentesis was performed under continuous real-time ultrasound guidance using a 21-gauge, 3.5-inch long spinal needle. Maternal serum alpha-fetoprotein (AFP) levels were determined before, at 5 minutes and at 1 hour after amniocentesis. There were no significant changes in maternal serum AFP levels either at 5 minutes or at 1 hour after amniocentesis. Midtrimester genetic amniocentesis performed by a trained and experienced operator under continuous ultrasound guidance does not significantly increase the risk of fetomaternal hemorrhage after the procedure.

Feto-maternal transfusion [FMT] in normal pregnancy and labour

This work comprised 100 women who were pregnant or in labour. The chief aim of the work was determination of incidence and amount of FMT in 40 cases of normal pregnancy ranging from 8-40 weeks of gestation, and 30 cases of normal labour. Also, comparing FMT value in these normal conditions to that of 13 cases of preeclampsia, 7 cases of antepartum haemorrhage and 10 cases of caesarean section. Queenan's technique of the acid elution test of Kleihauer was used for determination of incidence and amount of FMT. In this study the incidence of FMT in all cases of normal pregnancy was 57.5 percent [23 out of 40 cases], the amount of FMT ranged between 0.04 and 0.17 ml blood. An interesting observation is that the amount of FMT increases as pregnancy advances. There was positive correlation between FMT and the gestational age. There was insignificant correlation between FMT and gravidity or age of the women studied. The incidence of FMT in cases of normal labour was 70 percent [21 out of 30 cases]. There was a significant rise of FMT value after normal labour. There was a distinct increase in the FMT level in cases of preeclampsia as well as cases of antepartum haemorrhage when compared to the level in cases of normal pregnancy. All cases of caesarean section showed significant increase in FMT value following the operation

Studies on the prenatal chromosomal analysis and the changes of maternal serum alpha-fetoprotein following chorionic villus sampling

Transcervical chorionic villus sampling (CVS) was performed in 174 patients between 7 & 12 menstrual weeks of pregnancy opting for prenatal diagnosis. Advanced maternal age was the most common indication for CVS (39.7%). The sampling success rate was 95.4% (166/174), representing 88.9% at 7 to 8 weeks, 98.9% at 9 to 10 weeks & 92.7% at 11 to 12 weeks gestation. In 139 of 174 patients (80%), successful sampling was accomplished in one or two catheter passages only. Four spontaneous fetal losses (2.3%) occurred. The cytogenetic analysis routinely used was the direct overnight & long-term culture methods which revealed 4 abnormalities (2.4%). To date, 90 of the women have been delivered & all infants are doing well and the remaining 65 pregnancies are continuing uneventually. Maternal serum alphafetoprotein (MSAFP) concentration was determined in 72 patients immediately before & after CVS. A significant increase of 20% or more, comparable to pre CVS levels, was noted immediately after sampling in 56 of 72 patients (77.8%). The increase in MSAFP concentration correlated with the amount of villi sampled (r = 0.498, p less than 0.001) & with the number of sampling attempts (p less than 0.05). Estimated CVS related fetomaternal hemorrhage (FMH) ranged from 0.005 to 0.1552 ml and in 5 of 72 patients (6.90%) 0.06 ml or more of FMH was noted. Two of the 5 patients had FMH of 0.1 ml or more.