Obstetric and Gynaecology Department, "IRCCS Policlinico S. Matteo", Pavia, Italy.
Immunotransfusion Department, "IRCCS Policlinico S. Matteo", Pavia, Italy.
Blood Transfus. 2018 May;16(3):302-306. doi: 10.2450/2017.0316-16. Epub 2017 Apr 19.
Foeto-maternal haemorrhage (FMH), a gestational event that occurs before or during delivery, consists of a loss of foetal blood into the maternal circulation. FMH occurs more frequently during the third trimester or labour both in normal and complicated pregnancies. In the case of alloimmunisation, the maternal immunological response and the severity of the resulting foetal or neonatal disease depend on the amount of foetal blood that passes into the maternal circulation. The aim of this study was to determine FMH in the third trimester and at term of pregnancy and to evaluate the role of clinical and ultrasound markers in the prediction of FMH.
FMH was quantified by cytofluorimetric testing at 28 to 35 weeks of gestation in 223 women and at term in 465 women, all with risk factors. Foetal evaluation included foetal movement profile, middle cerebral artery peak velocity of systolic blood flow (MCA-PSV) and cardiotocographic monitoring.
All women tested negative for FMH in the third trimester. Four patients (0.9%) tested positive at term, with estimated volumes of bleeding of 2.2, 8.1, 12.3 and 39.8 mL. Three FMH cases (75%) had a non-reassuring cardiotocography compared to 8.9% (42/461) of women without FMH (p=0.003) and two FMH cases reported a reduction in foetal movements reduction compared to four of those without FMH (p=0.001). Mean MCA-PSV was normal in both the groups with and without FMH (p=0.22).
FMH is rare in pregnancy and at term. Cytofluorimetric testing is a specific method to detect mild-to-moderate FMH even when the MCA-PSV is not informative. Mild-to-moderate FMH is significantly associated with reduced foetal movements and non-reassuring cardiotocographic monitoring.
胎母出血（FMH）是一种发生在分娩前或分娩期间的妊娠事件，是胎儿血液进入母体循环的损失。在正常和复杂的妊娠中，FMH 在第三孕期或分娩时更为常见。在同种免疫的情况下，母体的免疫反应和由此产生的胎儿或新生儿疾病的严重程度取决于进入母体循环的胎儿血液量。本研究旨在确定妊娠晚期和足月时的 FMH，并评估临床和超声标志物在预测 FMH 中的作用。
在有危险因素的 223 名妇女中，在 28 至 35 周妊娠时通过流式细胞仪检测 FMH，在 465 名妇女中在足月时进行检测。胎儿评估包括胎儿运动模式、大脑中动脉收缩期血流峰值速度（MCA-PSV）和胎心监护。
所有妇女在第三孕期的 FMH 检测均为阴性。4 名患者（0.9%）在足月时检测为阳性，估计出血量分别为 2.2、8.1、12.3 和 39.8 毫升。3 例 FMH 病例（75%）的胎心监护不令人满意，而无 FMH 的 461 名妇女中（8.9%）有 42 名（p=0.003）。与无 FMH 的妇女相比，有 2 例 FMH 病例报告胎儿运动减少，而无 FMH 的妇女中有 4 例报告胎儿运动减少（p=0.001）。有和无 FMH 的两组 MCA-PSV 均正常（p=0.22）。
FMH 在妊娠和足月时很少见。流式细胞仪检测是一种检测轻度至中度 FMH 的特异性方法，即使 MCA-PSV 没有信息。轻度至中度 FMH 与胎儿运动减少和胎心监护不令人满意显著相关。
