Reduced fetal movement during pregnancy: Is the Kleihauer-Betke test really useful?

Athiel, Yoann; Maisonneuve, Emeline; Bléas, C.; Maurice, P; Cortey, A.; Toly-Ndour, Cécile; Huguet-Jacquot, Stéphanie; Mailloux, Agnès; Jouannic, Jean‐Marie

doi:10.1016/j.jogoh.2020.101748

Cited by 6 publications

(9 citation statements)

References 23 publications

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“…Antenatal Kleihauer–Betke testing has limitations in its prognostic value, in the setting of trauma, external cephalic version, decreased fetal movement, and detection of anemia 20,28‐31 . However, we agree with Bataille, that the utility of the Kleihauer–Betke test is not to screen for fetal anemia antenatally but instead to explain fetal/neonatal anemia 21 .…”

Section: Discussionsupporting

confidence: 63%

Fetomaternal hemorrhage: Evidence from a multihospital healthcare system that up to 40% of severe cases are missed

et al. 2021

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Background We previously reported fetomaternal hemorrhage (FMH) in 1/9160 births, and only one neonatal death from FMH among 219,853 births. Recent reports indicate FMH is not uncommon among stillbirths. Consequently, we speculated we were missing cases among early neonatal deaths. We began a new FMH initiative to determine the current incidence. Methods We analyzed births from 2011 to 2020 where FMH was diagnosed. We also evaluated potential cases among neonates receiving an emergent transfusion just after birth, whose mothers were not tested for FMH. Results Among 297,403 births, 1375 mothers were tested for FMH (1/216 births). Fourteen percent tested positive (1/1599 births). Of those, we found 25 with clinical and laboratory evidence of FMH adversely affecting the neonate. Twenty‐one received one or more emergency transfusions on the day of birth; all but two lived. We found 17 others who received an emergency transfusion on the day of birth where FMH was not tested for, but was likely; eight of those died. The 42 severe (proven + probable) cases equate to 1/7081 births. We judged that 10 of the 42 had an acute FMH, and in the others it likely had more than a day before birth. Conclusions We estimate that we fail to diagnose >40% of our severe FMH cases. Needed improvements include (1) education to request maternal FMH testing when neonates are born anemic, (2) education on false‐negative FMH tests, and (3) improved FMH communications between neonatology, obstetrics, and blood bank.

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Section: Discussionsupporting

confidence: 63%

Fetomaternal hemorrhage: Evidence from a multihospital healthcare system that up to 40% of severe cases are missed

et al. 2021

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“…The amount that has been considered significant for causing fetal death has been described as somewhere between 80 and 150 mL at term 37 or >20 mL/kg 35 . In 99% of FMH cases volume of blood loss is less than 15 mL 38 . The degree of fetal compromise in FMH is dependent on the volume of blood lost in relation to fetal size and whether the bleeding is chronic or from a single event.…”

Section: The Role Of a Kleihauer Betke Test In Cases Of Dfmmentioning

confidence: 99%

“…The KBT is a labor‐intensive test requiring a skilled laboratory technician to stain and count fetal cells under the microscope – results may not be available “after‐hours” or may require a technician to be called in. Unfortunately, there is also significant variability between laboratories, and false positive results due to maternal hemoglobinopathy 38,39 . Overall, the KBT tends to overestimate the volume of FMH and may not be informative of fetal anemia.…”

Section: The Role Of a Kleihauer Betke Test In Cases Of Dfmmentioning

confidence: 99%

Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop

Bradford,

Hayes,

Damhuis

et al. 2023

Intl J Gynecology & Obste

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Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research.

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“…In women with RFM in the third trimester of pregnancy, it is mandatory to perform a non-stress test/CTG. 2 According to National Institute of Child Health and Human Development, and concerning CTG, category III fetal heart rate (FHR) pattern is associated with an increased likelihood of severe hypoxia and metabolic acidemia. Sinusoidal pattern is considered a category III FHR pattern.…”

Section: Descriptionmentioning

confidence: 99%

Sinusoidal pattern: a key to a rare case of fetal anaemia

Sá

Moura

2021

BMJ Case Rep

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Reduced fetal movement during pregnancy: Is the Kleihauer-Betke test really useful?

Cited by 6 publications

References 23 publications

Fetomaternal hemorrhage: Evidence from a multihospital healthcare system that up to 40% of severe cases are missed

Fetomaternal hemorrhage: Evidence from a multihospital healthcare system that up to 40% of severe cases are missed

Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop

Sinusoidal pattern: a key to a rare case of fetal anaemia

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