Risk factors for fetal-to-maternal transfusion in Rh D-negative women – results of a prospective study on 942 pregnant women

David, Matthias; Smidt, Julia; Chen, Frank C.-K.; Stein, Ursula; Dudenhausen, Joachim W.

doi:10.1515/jpm.2004.047

Cited by 16 publications

(19 citation statements)

References 15 publications

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“…[7][8][9] However, until now there was no clear evidence for this policy. Several cohort studies showed no correlation between assisted delivery and the presence of FMH, but none of these studies provided data about subsequent immunisation [15][16][17][18][19]27 Our results suggest that, at least in the above mentioned studies, the sensitivity and the specificity of the Kleihauer-Betke test were apparently insufficient in demonstrating increased FMH after a non-spontaneous delivery. This can be explained in several ways.…”

Section: Discussioncontrasting

confidence: 54%

“…Existing studies using the Kleihauer proxy show varying results and provide no evidence for a correlation between large FMH and the incidence of events, accepted as risk factors for FMH, for example, caesarean section. [15][16][17][18][19] Salim et al 19 performed the largest prospective controlled study on 313 women who underwent caesarean section and 253 women with a vaginal delivery, and did not find any evidence for a relation between the mode of delivery and the rate of large FMH. Differences in the application of the Kleihauer-Betke test (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Koelewijn

Haas

Vrijkotte

et al. 2010

Obstetrical &Amp; Gynecological Survey

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Objective To identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor.Design Case-control study.Setting Nation-wide evaluation of the Dutch antenatal anti-D-prophylaxis programme.Population Cases: 42 RhD-immunised parae-1, recognised by first-trimester routine red cell antibody screening in their current pregnancy, who received antenatal and postnatal anti-D Ig prophylaxis (gifts of 1000 iu) in their first pregnancy. Controls: 339 parae-1 without red cell antibodies.Methods Data were collected via obstetric care workers and/or personal interviews with women.Main outcome measure Significant risk factors for RhD immunisation in multivariate analysis.Results Independent risk factors were non-spontaneous delivery (assisted vaginal delivery or caesarean section) (OR 2.23; 95% CI:1.04-4.74), postmaturity ( ‡42 weeks of completed gestation: OR 3.07; 95% CI:1.02-9.02), pregnancy-related red blood cell transfusion (OR 3.51; 95% CI:0.97-12.7 and age (OR 0.89/year; 95% CI:0.80-0.98). In 43% of cases, none of the categorical risk factors was present.Conclusions In at least half of the failures of anti-D Ig prophylaxis, a condition related to increased fetomaternal haemorrhage (FMH) and/or insufficient anti-D Ig levels was observed. Hence, RhD immunisation may be further reduced by strict compliance to guidelines concerning determination of FMH and accordingly adjusted anti-D Ig prophylaxis, or by routine administration of extra anti-D Ig after a non-spontaneous delivery and/or a complicated or prolonged third stage of labour.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Koelewijn

Haas

Vrijkotte

et al. 2010

Obstetrical &Amp; Gynecological Survey

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“…[9] Maternal, pregnancy, or neonatal risk factors appropriate for early screening or diagnosis of FMH in the general population have not been elucidated. [14,15]…”

Section: Discussionmentioning

confidence: 99%

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Stroustrup¹,

Plafkin

Savitz³

2014

Neonatology

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Background: Fetomaternal hemorrhage (FMH) is a poorly understood condition in which the placenta allows transmission of fetal whole blood to the mother. FMH can cause fetal anemia resulting in critical illness, death or lifelong disability. Ascertainment of the incidence of FMH is limited by reliance on retrospective studies that are dependent on a diagnosis of FMH being made at the time of patient presentation. Objective: To determine whether the diagnosis of FMH is made more frequently after an educational intervention to increase physician awareness of the condition. Methods: This is a retrospective cohort study of all neonates born at our institution from 1988 through 2010. The medical records of all neonates diagnosed with anemia in the first 24 h of life were reviewed. The incidence of FMH as a documented etiology of anemia was compared between infants born before and after our educational intervention. Results: Of 124,738 births during the study period, 572 neonates with neonatal anemia were identified. A total of 23 cases of FMH demonstrated by positive Kleihauer-Betke testing occurred in our cohort. The incidence of diagnosed FMH prior to our intervention was 22 per 1,000 anemic neonates compared to 182 per 1,000 afterwards (p < 0.001), while the incidence of neonatal anemia remained unchanged (p = 0.377). Conclusions: FMH may be a significant cause of neonatal anemia. Diagnosis of FMH is highly dependent on physician awareness of the condition. Incorrect or absent diagnosis of the etiology of neonatal anemia has significant implications for our understanding of the epidemiology of FMH.

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“…[5, 6, 10, 14] Additional reports of FMH are limited to case studies and small series, and have not broadened the understanding of predisposing clinical or demographic factors for the majority of cases of FMH. [7, 16, 22] A recent study of placental pathology indicating that placental inflammation may play a role in FMH[8] provides a promising novel lead that deserves further evaluation for clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…These risk factors are not present in the majority of cases of severe FMH, however, and commonly occur without FMH as a notable sequellae. [1, 5, 6, 10, 14–16] No prospective epidemiologic study of FMH has been completed in the general pregnant population, and predisposing factors for FMH are unknown in the vast majority of identified cases. [1, 2, 15, 16]…”

Section: Introductionmentioning

confidence: 99%

Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study

Stroustrup

Plafkin²,

Tran³

et al. 2016

Neonatology

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Background: Fetomaternal hemorrhage (FMH) signifies failure of the placental barrier with whole blood transfer. Fetal anemia following FMH is associated with significant morbidity and mortality. If FMH is identified early, fetal anemia can be treated to minimize adverse outcomes. Risk factors for FMH are not known, limiting efforts to provide targeted screening for FMH. Objective: To identify maternal and/or pregnancy characteristics associated with FMH that are recognizable prior to fetal morbidity. Methods: This is the first published case-control study of FMH. Cases were identified from a prospectively maintained database of all hospital births between 1988 and 2010. Each case was matched to 4 controls by date and time of birth, allowing for assessment of a wide range of clinical and demographic data. Logistic regression modeling was used to assess the association between demographic and clinical characteristics and the diagnosis of FMH. Results: A total of 23 mother-baby pairs impacted by FMH and 92 matched controls were evaluated. Compared to controls, case mothers were more likely to have private insurance and to work outside the home and at night during pregnancy. Cases were more likely to be delivered preterm, but preterm labor was not more common among cases. There was no difference in race/ethnicity of cases compared to controls. Conclusions: Severe FMH is associated with significant morbidity and mortality of the affected neonate. Women with FMH were more likely to work outside the home during pregnancy than women with normal pregnancies. This finding has implications for third-trimester screening of pregnant women who work in strenuous fields.

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Risk factors for fetal-to-maternal transfusion in Rh D-negative women – results of a prospective study on 942 pregnant women

Abstract: Twin pregnancy is the only independent risk factor for severe fetal-to-maternal transfusion. ABO-incompatibility between mother and infant seems to be protective against Rh D-alloimmunization.

Cited by 16 publications

References 15 publications

Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Impact of Physician Awareness on Diagnosis of Fetomaternal Hemorrhage

Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study

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