Huissoud C, Divry V, Rudigoz R-C
Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 69317 Lyon cedex 04, France.
J Gynecol Obstet Biol Reprod (Paris). 2009 Jun;38(4):286-97. doi: 10.1016/j.jgyn.2009.03.006. Epub 2009 Apr 18.
Fetomaternal hemorrhage is known to have a wide spectrum of clinical presentations. This large variability probably explains why there are still neither consensual classification nor management recommendations. Nevertheless, fetomaternal hemorrhage is a serious condition, which may cause life-threatening fetal anemia. Fetal tolerance mainly depends on the quantity of fetal blood loss as well as the rate at which it occurs. Decrease in perceived fetal movements represents the main clinical sign of fetomaternal hemorrhage and justify use of diagnostic tests such as the Kleihauer-Betke test. Large fetomaternal hemorrhages can also induce fetal hydrops and stillbirth. In this review, we emphasize the clinical and biological features of fetomaternal hemorrhages and we highlight the circumstances associated with false-negative and false-positive results of the Kleihauer-Betke test. We also propose an original algorithm for the management of fetomaternal hemorrhages.
胎儿-母体出血有多种临床表现。这种较大的变异性可能解释了为什么目前尚无共识性的分类方法和管理建议。然而,胎儿-母体出血是一种严重情况,可能导致危及生命的胎儿贫血。胎儿的耐受性主要取决于胎儿失血量及其发生速度。自觉胎动减少是胎儿-母体出血的主要临床征象,也是使用如克列豪尔-贝特克试验等诊断检查的依据。大量的胎儿-母体出血还可导致胎儿水肿和死产。在本综述中,我们强调了胎儿-母体出血的临床和生物学特征,并突出了与克列豪尔-贝特克试验假阴性和假阳性结果相关的情况。我们还提出了一种胎儿-母体出血管理的原创算法。