La Roche Sur Yon Hospital, boulevard Stéphane Moreau, La Roche Sur Yon, France.
Sainte Thérèse Private Hospital, Paris, France.
J Matern Fetal Neonatal Med. 2022 Oct;35(19):3670-3676. doi: 10.1080/14767058.2020.1837768. Epub 2020 Oct 26.
The aim of this study was to correlate antenatal Kleihauer (KT) test results with fetal hemoglobin at birth to find a threshold for predicting severe fetal anemia. The secondary objectives were to assess the impact of KT on obstetric management and to study the correlation between the middle cerebral artery peack systolic velocity and fetal anemia.
One thousand forty-six KT were positive over the 10-year period, but only 147 were included from 88 patients, of which 17 fetuses were anemic. Demographic and obstetric characteristics were similar between anemic and non-anemic groups. As regards new-born, there was a higher risk of prematurity among anemic as long as a lower birth rate in accordance. While a negative correlation was observed between KT and hemoglobin at birth, no KT upper threshold could be found that was both sensitive and specific. In addition, there was no case of fetal anemia when KT was repeated, even though it increased. KT showed little usefulness in obstetrics management to help improving neonatal care for anemia. Conversely, the MCA PSV demonstrated good performance in this matter and the ROC curve area was 0.91 (figure).
Feto-maternal hemorrhage is a rare but grave pathology which could lead to anemia. The most common clinical sign is reduced fetal movement and it was the main indication to perform a KT. Cardiotocography patterns suggestive of anemia are sinusoidal, micro-oscillatory and non-reactive monitoring. Ultrasound features were polyhydramnios, hydrop fetalis and increased MCA peack systolic velocity. KT was correlated with MCA PSV and with hemoglobin level at birth. However, the latter showed a better diagnostic performance. MCA PSV measurement is a powerful test to screen for fetal anemia, and should be part of the regular training of obstetricians. Indeed, this technic gives immediate and reliable results, while those of KT are delayed.
The KT should not be used as a tool to screen for fetal anemia but rather as a test to explain a fetal anemia. However, the MCA PSV is reliable in this matter and give immediate result, thus obstetrician should be trained to routinely perform it.
本研究旨在将产前 Kleihauer（KT）试验结果与出生时胎儿血红蛋白相关联，以找到预测严重胎儿贫血的阈值。次要目的是评估 KT 对产科管理的影响，并研究大脑中动脉峰值收缩速度与胎儿贫血之间的相关性。
在 10 年期间，有 1046 次 KT 呈阳性，但仅从 88 例患者中纳入了 147 次，其中 17 例胎儿贫血。贫血组和非贫血组的人口统计学和产科特征相似。至于新生儿，贫血组早产风险较高，出生体重较低。虽然观察到 KT 与出生时血红蛋白呈负相关，但未找到既敏感又特异的 KT 上限。此外，即使 KT 增加，也没有再次出现胎儿贫血的病例。KT 在产科管理中几乎没有帮助，无法改善新生儿对贫血的护理。相反，MCA PSV 在这方面表现良好，ROC 曲线面积为 0.91（图）。
胎儿-母体出血是一种罕见但严重的病理情况，可能导致贫血。最常见的临床体征是胎动减少，这是进行 KT 的主要指征。提示贫血的胎心监护图形为正弦、微振荡和无反应监护。超声特征为羊水过多、胎儿水肿和大脑中动脉峰值收缩速度增加。KT 与 MCA PSV 和出生时的血红蛋白水平相关。然而，后者表现出更好的诊断性能。MCA PSV 测量是筛查胎儿贫血的有力手段，应成为产科医生常规培训的一部分。事实上，该技术可立即提供可靠的结果，而 KT 的结果则延迟。
KT 不应作为筛查胎儿贫血的工具，而应作为解释胎儿贫血的试验。然而，MCA PSV 在这方面是可靠的，并且可以立即得出结果，因此应培训产科医生常规进行此项检查。
