Post amniocentesis, amnioreduction, insertion of fetal amniotic shunts. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. The kleihauer betke kb test, kleihauer betke kb stain, kleihauer test or acid elution test, is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mothers bloodstream. Is the kleihauer betke test a reliable indicator of foetomaternal haemmorrhage. Women who present with major or massive haemorrhage should also have liver and renal function blood tests and a coagulation screen including klauss fibrinogen. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption.
Used to determine the required dose of rh immune globulin. Antepartum haemorrhage aph or prepartum hemorrhage is defined as. Kleihauer test is recommended in rhnegative mothers. Antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term. Role of kleihauer test in detection of fetomaternal. Diagnosis antepartum if the placenta is low lying or there is multiple. The apt test is most commonly used in cases of vaginal bleeding late during pregnancy antepartum haemorrhage to determine if the bleeding is from the mother or the fetus. The most common investigations performed are cardiotocography ctg, ultrasound scan uss and umbilical artery doppler. Antihbf flow cytometry is a promising alternative, although its use is limited by equipment and staffing costs.
Reduced fetal movements can be the only presenting symptom. Antepartum haemorrhage aph complicates 25% of pregnancies and is defined in some literature as any bleeding from the genital tract after the 20 th week of pregnancy and before labour. Some form of dic is present in up to 20% of patients with severe abruptions. Blood films were fixed in 80% ethanol and slides were then allowed to stand at 37oc in a citric phosphate buffer for 5 min. Antepartum haemorrhage guideline for management 19. General examination, besides the initial assessment. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. A negative kleihauer test indicates that one dose of rhdig is sufficient. A standard blood smear is prepared from the mothers blood, and exposed to an acid bath. Describe an appropriate management plan based on the probable cause.
Antepartum haemorrhage flowchart moet iv access site two largebore size 14 or 16 gauge iv cannulae. This guideline is for the use of all staff involved in the management of women with an antepartum haemorrhage. C the kleihauer test is not a sensitive test for diagnosing abruption. It is used to assess the volume of a fetomaternal haemorrhage fmh and determine if additional doses of rhdig are required. Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops. May 11, 2017 antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. The most common investigations performed are cardiotocography ctg, ultrasound scan uss and. Recurrent aph is the term used when there are episodes of aph on more than one occasion. Use of aspirin before 16 weeks of pregnancy to prevent preeclampsia also appears effective at preventing. Hospital based crosssectional study was conducted among 75 rhd negative pregnant mothers using.
Definition antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term. Kleihauer betke test findings may help to determine the appropriate dosage of rh o d immune globulin in cases of significant fetalmaternal hemorrhage. It can occur at any time until the second stage of labour is complete. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Kleihauer betke bedside clot test other investigations di ctated by presence of comorbid conditions e. Antepartum haemorrhage is defined as bleeding from the genital tract after the 20th week of pregnancy and. This includes midwifery, obstetric, anaesthetic, imaging. There is no consensus among obstetricians regarding the optimum management of reduced foetal movements.
Antepartum haemorrhage aph including placental abruption. Antepartum haemorrhage aph is bleeding from the genital tract after 20. Kleihauerbetke test can distinguish fetal from maternal red blood cells. To determine if patientspecific doses of prophylactic antid warrant further investigation in ethiopia and wider africa.
Although the kleihauer betke test is inexpensive and requires no special equipment, it lacks standardization and precision, and may not be accurate in conditions with elevated fcells. Antepartum hemorrhage antepartum hemorrhage definition vaginal bleeding after 20 wks gestation. Antepartum haemorrhage or bleeding in the second half. The kleihauer test is used to identify women with a large fetomaternal haemorrhage 6 ml of packed fetal red cells who may need additional doses of rhd immunoglobulin rhdig to ensure clearance of all fetal red cells. Manual removal of placenta after a previous pregnancy. The acid elution technique described by kleihauer was used to demonstrate fetal cells. Because it can lead to death of the mother and fetus, the pregnant sufferer must be admitted to hospital for proper assessment. Antepartum hemorrhage a 30 year old g2p1 with previous spontaneus vaginal delivery and appropriately grown fetus is admitted at term with fresh vaginal bleeding and abdominal pain.
The kleihauer test and fetomaternal haemorrhage birth. The rcog guideline recommends that all patients with aph should have a full blood count fbc and a group and save. It is recommended that wherever possible a transplacental haemorrhage of greater than 4 ml should be confirmed by flow cytometric analysis. C ultrasound can be used to diagnose placenta praevia but does not exclude. The original and complete rcog guideline can be found at the below link for your reference. Mar 11, 2016 antepartum haemorrhage aph is usually defined as bleeding from the birth canal after the 24th week of pregnancy. The writing group produced the draft guideline which was subsequently revised by. Antepartum haemorrhage definition bleeding from the vagina any time after 24 weeks gestation until the birth of the baby blood loss greater than 300mls or any amount causing hypovolaemic shock incidence 35% of all pregnancies. Antepartum haemorrhage king edward memorial hospital.
Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 20th to 24th week of pregnancy up to delivery. Fibrinogen levels rise in pregnancy so normal or low levels and prolonged prothrombin time suggest disseminated intravascular. In this article, we shall look at the pathophysiology, clinical features and management of placenta praevia. Kleihauerbetke test is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to the mothers bloodstream. Feto maternal haemorrhage, transplacental haemorrhage, kleihauer, kleihauer betke, haemolytic disease of the fetus and newborn, antid immunoglobulin, flow cytometry, acid elution. For antepartum kleihauer tests, the result may stay positive in cases where the fetus is rhd negative even though one or more doses of rhdig have been given. Additional management considerations for major aph kleihauer test should be performed in rhesus dnegative women for administration of antid refer to separate guideline.
A kleihauer test may also help to establish the type of antepartum haemorrhage which has occurred, by determining the presence or absence of a fetomaternal haemorrhage. Antepartum haemorrhage the royal childrens hospital. Fetoprotein afp concentration and kleihauer staining of maternal blood, taken both before and after the procedure, revealed increases in afp values of more than 40 per cent in 30 per cent of the patients examined. Antepartum haemorrhage aph including placental abruption definition. If a woman presents more than 2 hours following a sensitising event a kleihauer must still be taken.
Dat direct coombes test a test performed to detect any maternal antibodies that may be attached to the infants rbc. A positive test would indicate that blood is of fetal origin, and could be due to vasa previa. Massive fetomaternal haemorrhage fmh of more than 30 ml can cause significant fetal morbidity and mortality. A kleihauer test should not be requested in the setting of an antepartum haemorrhage in order to diagnose abruption. Management of aph in general there are few high quality clinical trials to guide the management of antepartum haemorrhage or abruption, where there is high quality evidence this is noted below. Ectopic pregnancy and miscarriage cg154 published date. Detection of fetomaternal hemorrhage kim 2012 american. Antepartum haemorrhage clinical practice guidelines. Pdf comparison of estimation of volume of fetomaternal. It takes advantage of the differential resistance of foetal hemoglobin to acid.
Placenta praevia is where the placenta is fully or partially attached to the lower uterine segment. Oct 05, 2016 fetomaternal haemorrhage lead to severe rh sensitization in rh negative mother a kleihauer betke or similar test is essential 1. Clinical use of the kleihauer betke test clinical use of the kleihauer betke test holcomb, william l gunderson, erik. Antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. Hospital based crosssectional study was conducted among 75 rhd negative pregnant mothers using convenient. The kleihauer test the kleihauer test is performed on a maternal sample. Antid gamma globulin should be administered to all rhesus negative women, with the dose being determined by a kleihauer test to give an estimate of the size of the feto.
Do not use a kleihauer test for quantifying feto maternal. The kleihauer test is not a sensitive test for diagnosing placental abruption. This study aimed to assess fetomaternal hemorrhage fmh among rhd negative pregnant mothers using two techniques, kleihauer betke kbt and flow cytometry fcm. Evidencebased information on kleihauer test from hundreds of trustworthy sources for health and social care. A kleihauer test may also help to establish the type of antepartum haemorrhage which has occurred, by determining the presence or absence of a fetomaternal. Fetomaternal haemorrhage lead to severe rh sensitization in rh negative mother a kleihauer betke or similar test is essential 1. If the first ctg shows a sinusoidal pattern a kleihauer test can be requested immediately. Comparison of estimation of volume of fetomaternal hemorrhage using kleihauer betke test and microcolumn gel method in dnegative nonisoimmunized mothers. Ctg ultrasound mx principles resuscitate call for help.
Antepartum haemorrhage placenta childbirth free 30day. Differentiate the clinical features of placenta previa, abruptio placenta and other possible causes. Fibrinogen, kleihauer if rh negative, group and x match minimum 4 units. The kleihauerbetke test is a blood test used to measure the amount of foetal hemoglobin transferred from a foetus to its mothers bloodstream. A kleihauer must be taken within 2 hours of an antenatal sensitising event andor birth. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester. Results for kleihauer test 1 10 of 21 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download export csv export ris 10 per page 50 per page 100 per page 250 per page. Antepartum haemorrhage assessment hx examination vitals general abdominal exam avoid pvspec until placenta praevia excluded investigations mum. Antepartum hemorrhage knowledge for medical students and. Fetomaternal haemorrhage fmh was studied after 46 cordocenteses. Betke test for fetal rbc quantification 12, it is not without its limitations.
Moreover, up to 20% of preterm deliveries are associated with aph. Betke test is the most widely used test to quantify the volume of fmh 95% of laboratories participating in the 2009 cap proficiency testing for fetal rbc detection used the kleihauer. Placenta praevia causes clinical features management. Obstetric haemorrhage both antepartum and postpartum is one of the leading causes of. Clinical use of the kleihauerbetke test, journal of. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The most important causes of aph are placenta praevia and placental abruption, although these are not the most common.
Do not use a kleihauer test for quantifying fetomaternal haemorrhage. Lack of fetal cells in maternal blood does not preclude an absent abruption. Antepartum haemorrhage or bleeding in the second half of. Request pdf antepartum haemorrhage the incidence of antepartum haemorrhage aph is reported as 3. Kleihauer betke test is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to the mothers bloodstream. Rare causes include vasa previa and uterine rupture. Detection of fetomaternal haemorrhage associated with. Minor haemorrhage blood loss less than 50 ml that has settled major haemorrhage blood loss of 50 ml, with no signs of clinical shock massive haemorrhage blood loss greater than ml andor signs of clinical shock. What is the role of a kleihauerbetke test in the workup. None of the women had abdominal pain or vaginal bleeding.
Bcsh fetomaternal haemorrhage 2009 amended september. Avoid vaginal examination until placenta praevia is excluded. Women who present after 24 weeks gestation need not be offered ffdna please follow pathway one appendix one sensitising events antepartum haemorrhage. It can be associated with reduced fetal birth weight.
Aph complicates 35% of pregnancies and is a leading cause of. Charbit et al reported a 100% positive predictive value for fibrinogen levels equal to or less than 200 mgdl in detecting severe postpartum haemorrhage, whereas levels greater than or equal to 400 mgdl have a 79% negative predictive value. For a full summary of kleihauer indications refer to wnhs transfusion protocols. A kleihauer test is also necessary for all rhesus negative women. If this method is not available then a separate operator should confirm the fmh by the kleihauer technique or if this is not possible, e. The kleihauerbetke kb test, kleihauer test, is a blood test used to. It is an important cause of antepartum haemorrhage vaginal bleeding from week 24 of gestation until delivery. Antepartum haemorrhage is a relatively common entity with potentially serious implications for the mother and the fetus. D the kleihauer test should be performed in rhesus d rhdnegative women to quantify fetomaternal haemorrhage fmh in order to gauge the dose of antid immunoglobulin antid ig required. Post fetal death in utero fdiu when fetal blood group is unknown.
A kleihauer betke test should be considered in all trauma patients because it may be an indicator of the severity of uterineplacental trauma and those that are at risk for preterm labor muench. On examination she is distressed with pain, pale, her pulse is 100 bpm, blood pressure 11080 mmhg, and she has a tender uterus contracting 310minutes. If there are signs of fetal or maternal compromise, consider immediate delivery. Bcsh fetomaternal haemorrhage 2009 amended september 2009.