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|Year : 1985 | Volume
| Issue : 1 | Page : 43-5
Foetal bleeding in the first and second trimester uterine haemorrhage.
Parulekar SV, Madhav HT, Ramanan SV, Joglekar SJ
|How to cite this article:|
Parulekar S V, Madhav H T, Ramanan S V, Joglekar S J. Foetal bleeding in the first and second trimester uterine haemorrhage. J Postgrad Med 1985;31:43
|How to cite this URL:|
Parulekar S V, Madhav H T, Ramanan S V, Joglekar S J. Foetal bleeding in the first and second trimester uterine haemorrhage. J Postgrad Med [serial online] 1985 [cited 2020 Feb 22];31:43. Available from: http://www.jpgmonline.com/text.asp?1985/31/1/43/5420
Vaginal bleeding is seen during pregnancy when the placental venous sinuses are opened especially during threatened abortion. A break in the placental stemvilli in this process would result in an admixture of foetal blood with maternal blood. This pilot study was undertaken to decide the prognostic value of the detection of foetal RBCs in the maternal vaginal blood.
Fifty cases of threatened abortion and 25 cases of inevitable abortion were studied in each of the first two trimesters. Vaginal blood smears were obtained in all patients. In cases with threatened abortion, the smears were obtained first on admission and subsequently once a day till the patient stopped bleeding or went into inevitable abortion. Smears were made only once in cases of inevitable abortion. Patients with threatened abortion were treated conservatively with bed rest, injectable 17 a-hydroxyprogesterone acetate (250 mg I.M. every week) and oral isoxsuprine hydrochloride (10 mg 6 hourly). They were followed upto the term for any recurrence of vaginal bleeding.
Peripheral blood smears were obtained in all cases on admission. All smears were stained by a modified Kleihauer-Betke test to detect foetal RBCs, keeping the pH of the buffer between 3.1 and 3.3.,
Statistical evaluation of the data was done using Chi square test.
[Table - 1] shows the distribution of all patients into various groups and also the overall results. Thirty-three cases in the first trimester and 35 cases in the second trimester continued pregnancy and went to term. However, 17 from the first and 15 from the second trimester progressed to inevitable abortion. Among these patients with threatened abortion progressing to inevitable abortion, 9 in the 1st trimester and 10 in the 2nd trimester had a positive Kleihauer-Betke test. Only one case each in the first 2 trimesters had the test positive in the group of threatened abortion that continued pregnancy and went to term. Among those presenting with inevitable abortion, 9 from the 1st trimester and 10 in the second trimester had the test positive. Patients of threatened abortion progressing to inevitable abortion and also having a positive test on their peripheral blood smear showed test positivity on the vaginal blood smear too. Of the two patients who continued pregnancy and having the peripheral blood smear test positive, only one had vaginal blood smear test positive. All cases of inevitable abortion who had the test positive on the peripheral blood smears, had the test positive on the vaginal blood smears too.
Upto 21% of haemoglobin in an adult can be Hb-F. It can also be found in the maternal blood in some conditions (other than feto-maternal haemorrhage) such as sickle cell disease, Hb-C, Hb-D, Hb-E disease, ß-thalassemia minor etc. In these cases, such cells will also be found in the maternal vaginal blood. Hence, maternal peripheral blood smears were made and used as controls.
On comparing the data in cases of threatened abortion progressing to inevitable abortion, with other groups of those continuing pregnancy and inevitable abortion, it was seen that the KleihauerBetke test was positive in the vaginal blood smears in 19, 2 and 19 cases in these 3 groups respectively and in the maternal peripheral blood smears in 3, 2 and 10 cases respectively. This indicates that the presence of foetal RBCs in the maternal vaginal blood smears in cases of threatened abortion in both the 1st and 2nd trimesters is associated with a great risk of progression to inevitable abortion. However, the presence of foetal RBCs in the maternal peripheral blood does not indicate any such increased risk. 38% cases of inevitable abortion had the test positive on maternal vaginal blood. Since satisfactory blood smears could not be obtained in quite a few cases of inevitable abortion, due to the presence of large blood clots, this figure is likely to be deceptively low.
With a modified Kleihauer-Betke test using a buffer pH of 2.8-2.9, one could test the embryonal haemoglobins (Gower 1 and Gower 2) and be able to obtain greater number of positive results in pregnancies of less than 20 completed weeks of gestation. improving the prognostic value of the test further. Thus the presence of foetal RBCs in the maternal vaginal blood of uterine origin strongly suggests that the pregnancy would end as an inevitable abortion. This test may be used for prognosis in patients with threatened abortion.
We thank the Dean, Seth G.S. Medical College and K.E.M. Hospital, for allowing us to use the hospital data and to publish this paper.
|1.||Bauer, J. D., Ackerman, P. G. and Toro, G.: Determination of foetal haemoglobin in red blood cells by acid elution method of Kleihauer. From: Methods in Hematology. In, "Bray's Clinical Laboratory Methods." 7th Edition, Editor: J. D. Bauer, P. G. Ackerman and G. Toro, The C. V. Mosby Company, Saint Louis, 1968, pp. 170-171. |
|2.||Huntsman, R. G.: Haemoglobinopathies. In, "Scientific Basis of Obstetrics and Gynaecology." Editor: R. R. MacDonald, 2nd Edition, Churchill Livingstone, Edinburgh, London and New York, 1978, pp. 217-218. |
|3.||Ramanan, S., Ganguly, A. C. and Krishna, U. R.: Fetomaternal haemorrhage in induced abortion. J. Obstet. & Gynaecol. India. 30: 48-52, 1980. |