Fetomaternal Haemorrhage After External Cephalic Version at Term

Abstract

The incidence of fetomaternal haemorrhage after external cephalic version was 1.8% in 167 patients. The occurrence of this complication was not found to be associated with difficult or unsuccessful version, or with any adverse perinatal outcome. We conclude that routine assessment of fetomaternal haemorrhage after external version is not necessary, except in rhesus negative women to detect the 2% in whom the routine dose of 500 iu (100 micrograms) of anti-D immunoglobulin is inadequate.

Massive Feto-Maternal Haemorrhage with Good Perinatal Outcome following Failed External Cephalic Version

“…The largest bleed in their study was 117 cells/10,000 maternal cells, which corresponds to 6.5 ml of fetal red cells. Although Marcus et al [8] found an increase in the amount of FMH in cases with failed ECV, Tau et al [10] found no such association. Placental position has been related to success rates [3,6] and a posterior placenta is considered more favourable.…”

“…Placental position has been related to success rates [3,6] and a posterior placenta is considered more favourable. Tau et al [10] did not find an anterior placenta to be a predisposing factor for FMH. In our case the placenta was anteriorly situated, but it would be difficult to conclusively implicate this as a cause for the massive FMH in view of the above contradictory reports.…”

“…The largest amount of FMH was found in those with failed ECV. Lau et al [10] concluded that this complication was not particularly associated with unsuccessful version or any adverse perinatal outcome, and routine assessment of FMH is not nec-essary after external version except in rhesus-negative women. This was to detect those 2% in whom the standard dose of 500 IU of anti-D would not be sufficient.…”

“…The reported incidence of FMH following ECV is between 0 and 28% [5][6][7][8][9][10] depending on the amount of haemorrhage considered as significant, and the reported studies are summarised in table 1. The largest volume of FMH was 6.0 ml in the study by Marcus et al [8] and there were no adverse outcomes.…”

“…The role of ECV has thus become more important in our attempt to reduce caesarean rates. Fetomaternal haemorrhage (FMH) has been reported to occur with ECV [5][6][7][8][9][10], and concerns have been expressed regarding sub-clinical FMH, although it is not a common cause of perinatal mortality.…”