Flowcytometric assessment of fetomaternal hemorrhage during external cephalic version at term

Abstract

External cephalic version (ECV) at term is a safe procedure and reduces the incidence of cesarean sections for breech presentation. One of the known complications, however, is an ECV-related disruption of the placental barrier and a subsequent transfusion of fetal blood into maternal circulation. While the incidence of ECV-related fetomaternal hemorrhage (FMH) has been determined recently in a large trial using a manual Kleihauer-Betke test (KBT), questions remain on the amount of ECV-related FMH. KBT, which detects fetal red blood cells (RBC) on the basis of acidic resistance of fetal hemoglobin (HbF), is known to be a sensitive test, yet prone to procedural errors limiting its accuracy in quantifying FMH. In this study we investigated 50 patients for FMH before and after ECV, using a dual-color flow cytometric test kit with a lower limit of quantification of 0.05% fetal RBC in maternal peripheral blood. Three patients had a quantifiable increase of fetal RBC detected after ECV (0.06%; 0.08%; 0.1%). None of these subtle increments was predictable by ECV-related clinical parameters or translated into fetal compromise. Using a sensitive and accurate flow cytometric test method, our data provide further assurance to mothers on the safety of ECV at term.

Occult fetomaternal hemorrhage in women with pathological placenta with respect to permeability

“…In another study examining the risk of FMH after external cephalic version at term for women with breech presentation using the FCC system, although a higher cut‐off point of 0.05% was used compared to our cut‐off value of 0.02%, three occurrences of FMH were detected among 50 women (6.0%) after external cephalic version . These three FMH women showed HbF fraction sizes of 0.06%, 0.08%, and 1.0%, respectively …”

“…Indeed, in a study examining the incidence of positive Kleihauer-Betke test results in low-risk, third-trimester, and asymptomatic women, as many as five of 98 (5.1%) had a positive test result, indicating FMH of 5 mL and 40 mL in four and one cases, respectively. 16 In another study examining the risk of FMH after external cephalic version at term for women with breech presentation using the FCC system, 17 although a higher cut-off point of 0.05% was used compared to our cutoff value of 0.02%, three occurrences of FMH were detected among 50 women (6.0%) after external cephalic version. 17 These three FMH women showed HbF fraction sizes of 0.06%, 0.08%, and 1.0%, respectively.…”

“…16 In another study examining the risk of FMH after external cephalic version at term for women with breech presentation using the FCC system, 17 although a higher cut-off point of 0.05% was used compared to our cutoff value of 0.02%, three occurrences of FMH were detected among 50 women (6.0%) after external cephalic version. 17 These three FMH women showed HbF fraction sizes of 0.06%, 0.08%, and 1.0%, respectively. 17 In contrast to the FMH prevalence rate of 2.9% among control women, one of five women (20%) with PE alone, one of three with PP (33%), one of two with PA (50%), and one of one with PMD (100%) exhibited FMH.…”

“…In an earlier study by Christensen, one of three women with relatively severe FMH was complicated with PE. In a study examining the risk of FMH in 14 women with PE and 11 control women using the FCC system, the mean volume of FMH was significantly greater in women with PE than in controls (4.0 mL vs 1.0 mL, respectively) . Based on theoretical considerations, the prophylactic use of anti‐D immune globulin is recommended in PP patients with antenatal hemorrhage .…”

Chronic Viral Infections and Invasive Procedures: Risk of Vertical Transmission and Current Recommendations

“…The information available examines only feto-maternal contamination, which was estimated in an average of 0.1042 ml in CVS [16] and of 0.061 ml in cordocentesis [20] . Feto-maternal blood hemorrhage has also been described after external cephalic version [21,22] . The risk in fetal surgery has not been assessed.…”