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Stachurska-Skrodzka A, Mielecki D, Fijałkowska A, Żebrowska K, Kasperczak M, Kosińska-Kaczyńska K. Is Feto-Maternal Transfusion after Cesarean Delivery Different in Singleton and Twin Pregnancy? J Clin Med 2024; 13:3609. [PMID: 38930136 PMCID: PMC11204751 DOI: 10.3390/jcm13123609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/15/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n = 11), and monochorionic (n = 11) and dichorionic (n = 13) twin gestations were tested. Flow cytometry tests with hemoglobin F, glycophorin A, and hemoglobin F and carbonic anhydrase simultaneous staining were used to detect fetal red blood cells and maternal F cells. Results: In all cases, the volume of feto-maternal transfusion was estimated to be low. The highest rate of fetal red blood cells in the maternal circulation was observed in the blood of women with dichorionic twin gestations both before and after delivery. An increase in fetal red blood cells was observed after cesarean section in singletons and twins. The median rate of maternal F cells was 2.23% in singleton, 2.1% in monochorionic and 3.95% in dichorionic pregnancy. Conclusions: Feto-maternal transfusion during pregnancy may be related to the multiplicity and chorionicity of pregnancy.
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Affiliation(s)
- Anna Stachurska-Skrodzka
- Department of Cell Biology and Immunology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland; (A.S.-S.); (A.F.)
| | - Damian Mielecki
- Department of Neurochemistry, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Anna Fijałkowska
- Department of Cell Biology and Immunology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland; (A.S.-S.); (A.F.)
| | - Kinga Żebrowska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland; (K.Ż); (M.K.)
| | - Monika Kasperczak
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland; (K.Ż); (M.K.)
| | - Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland; (K.Ż); (M.K.)
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2
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Slootweg YM, Zwiers C, Koelewijn JM, van der Schoot E, Oepkes D, van Kamp IL, de Haas M. Risk factors for RhD immunisation in a high coverage prevention programme of antenatal and postnatal RhIg: a nationwide cohort study. BJOG 2022; 129:1721-1730. [PMID: 35133072 PMCID: PMC9543810 DOI: 10.1111/1471-0528.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations. DESIGN Prospective cohort study. SETTING The Netherlands. POPULATION Two-year nationwide cohort of alloimmunised RhD-negative women. METHODS RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined). RESULTS In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1-2.6), perinatal death (OR 3.5, 95% CI 1.1-10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2-16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1-3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0-9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001). CONCLUSION Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
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Affiliation(s)
- Y M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - C Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.,Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands
| | - J M Koelewijn
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - E van der Schoot
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - I L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M de Haas
- Centre for Clinical Transfusion Research, Sanquin Research, Amsterdam, the Netherlands.,Department of Immunohaematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Haematology, Leiden University Medical Center, Leiden, the Netherlands
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3
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Wikman A, Mörtberg A, Jalkesten E, Jansson Y, Karlsson A, Tiblad E, Ajne G. Altered strategy of prophylactic anti-D administration in pregnancy to cover term and post-term - a pilot study. Vox Sang 2021; 116:1005-1011. [PMID: 33772800 DOI: 10.1111/vox.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/10/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Routine antenatal anti-D prophylaxis (RAADP) to RhD-negative women is most often administered in gestational age (GA) 28-30 weeks with the next anti-D dose administered postpartum. The aim of this study was to analyse the proportion of RhD-negative women where RAADP is not detectable at term and in a pilot study to investigate whether RAADP administered in GA 28 and 38 results in detectable levels at term, post-term and post-delivery. MATERIALS AND METHODS In a retrospective analysis, 4280 RhD-negative women carrying an RHD positive fetus were included and the proportion with a negative antibody screen at delivery was determined. In the second part, 39 pregnancies were included prospectively, a second dose of RAADP was administered in GA 38 weeks, and anti-D was quantified before the second dose and then weekly for 5 weeks. RESULTS In the retrospective analysis, 20·5% (856/4280) with RAADP administered in GA 28 were negative in routine antibody screening at delivery. In the small prospective study, 18% (7/39) had a negative antibody screen and 26% (10/39) had levels below 0·005 IU/ml, in the quantification assay, in GA 38. Anti-D prophylaxis administered in GA 38 showed detectable levels of anti-D up to 30 days post-delivery, with concentration at delivery 0·060 ± 0·034 IU/ml (mean ± SD). CONCLUSION Approximately 20% of the RhD-negative women show non-detectable levels of anti-D at term. A second dose of RAADP at GA 38 results in stable concentrations of anti-D at term, post-term and post-delivery, but with large interindividual variation.
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Affiliation(s)
- Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Immunology, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Anette Mörtberg
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Division of Immunology, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Elisabeth Jalkesten
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Jansson
- Pregnancy Care & Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Karlsson
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Eleonor Tiblad
- Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Pregnancy Care & Delivery, Karolinska University Hospital, Stockholm, Sweden.,Division of Obstet & Gynecol, Department of CLINTEC, Karolinska Institute, Stockholm, Sweden
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4
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Visser GHA, Thommesen T, Di Renzo GC, Nassar AH, Spitalnik SL. FIGO/ICM guidelines for preventing Rhesus disease: A call to action. Int J Gynaecol Obstet 2021; 152:144-147. [PMID: 33128246 PMCID: PMC7898700 DOI: 10.1002/ijgo.13459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
The introduction of anti‐Rh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. The International Federation of Gynecology and Obstetrics, International Confederation of Midwives, and Worldwide Initiative for Rhesus Disease Eradication have reviewed current evidence regarding the utility of anti‐Rh(D) immunoglobulin. Taking into account the effectiveness anti‐Rh(D), the new guidelines propose adjusting the dose for different indications and prioritizing its administration by indication. These FIGO/ICM guidelines review the evidence regarding the usefulness of anti‐Rh(D) immunoglobulin, prioritizing its administration by indication.
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Affiliation(s)
- Gerard H A Visser
- International Federation of Gynecology and Obstetrics, London, UK.,Worldwide Initiative for Rh Disease Eradication, New York, NY, USA
| | - Trude Thommesen
- Worldwide Initiative for Rh Disease Eradication, New York, NY, USA.,International Confederation of Midwives, The Hague, the Netherlands
| | | | - Anwar H Nassar
- International Federation of Gynecology and Obstetrics, London, UK
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5
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Legler TJ. RhIg for the prevention Rh immunization and IVIg for the treatment of affected neonates. Transfus Apher Sci 2020; 59:102950. [PMID: 33004277 DOI: 10.1016/j.transci.2020.102950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rhesus D (RhD) negative pregnant women carrying an RhD positive fetus are at risk of developing anti-D during or after pregnancy. Anti-d-immunoglobulin (RhIg), which is mainly produced from special plasma donated in a few countries for the whole world, is able to prevent an anti-D alloimmunization. Through the introduction of ante- and postnatal anti-d-prophylaxis into clinical routine, the frequency of hemolytic disease of fetus and newborn decreased considerably. Postnatal prophylaxis from the beginning in the 1960s has been applied only to women who delivered an RhD positive newborn. Because the fetal RhD status can be determined with high sensitivity and accuracy from the mother's peripheral blood, targeted antenatal anti-d-prophylaxis is becoming a new standard procedure in more and more countries. Phototherapy and exchange transfusion are still the main pillars for the treatment of RhD hemolytic disease of the newborn. The efficacy of IVIg in the management of these neonates is not conclusive and cannot be recommended until a larger randomized, double-blind, placebo-controlled study is performed.
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Affiliation(s)
- Tobias J Legler
- Department of Transfusion Medicine, University Medical Center, Georg-August-University, Göttingen, Germany.
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6
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Gregory E, Towers CV, van Nes J, Shumard K, Fortner KB, Weitz B. Fetomaternal Bleeding and Neonatal Hematocrit following Cesarean Delivery: Routine versus Transplacental Transection. AJP Rep 2019; 9:e298-e301. [PMID: 31544010 PMCID: PMC6753006 DOI: 10.1055/s-0039-1697654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 11/02/2022] Open
Abstract
Objective To evaluate fetomaternal bleeding following routine cesarean delivery compared with cesarean delivery involving transplacental transection. Study Design A prospective cohort study evaluating cesarean delivery in which the placenta was transected (cases) versus controls (placenta not transected) from January 2016 to April 2018. A maternal Kleihauer-Betke's (KB) test and newborn hematocrit were performed shortly after delivery. Results The rate of a positive KB test was not significantly different between cases ( n = 31) and controls ( n = 61) (19 vs. 14%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.46-4.49; p = 0.74). Median neonatal hematocrits were not different. However, the rate of newborn hematocrits <40% at delivery was higher in cases compared with controls (23 vs. 3%; OR: 8.90; 95% CI: 1.72-45.90; p = 0.005). Conclusion A cesarean requiring transplacental transection to accomplish delivery does not significantly increase the rate of fetomaternal bleeding but is associated with a higher likelihood of newborn hematocrit <40% at delivery.
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Affiliation(s)
- Emily Gregory
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Craig V Towers
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Jaclyn van Nes
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Kristina Shumard
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Kim B Fortner
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Beth Weitz
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
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7
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Gokce A, Benlioglu C, Baydemir K, Kalafat E, Atabekoglu C. Cesarean delivery: A predisposing factor for autoimmune thyroid disease in iodine replete women? Eur J Obstet Gynecol Reprod Biol 2018; 224:131-132. [PMID: 29609184 DOI: 10.1016/j.ejogrb.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Ali Gokce
- Ankara University, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Can Benlioglu
- Ankara University, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Kaan Baydemir
- Ankara University, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erkan Kalafat
- Ankara University, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Cem Atabekoglu
- Ankara University, Department of Obstetrics and Gynecology, Ankara, Turkey
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8
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Mild-to-moderate foeto-maternal haemorrhage in the third trimester and at term of pregnancy: quantitative determination and clinical-diagnostic evaluation. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:302-306. [PMID: 28488965 DOI: 10.2450/2017.0316-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/02/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Foeto-maternal haemorrhage (FMH), a gestational event that occurs before or during delivery, consists of a loss of foetal blood into the maternal circulation. FMH occurs more frequently during the third trimester or labour both in normal and complicated pregnancies. In the case of alloimmunisation, the maternal immunological response and the severity of the resulting foetal or neonatal disease depend on the amount of foetal blood that passes into the maternal circulation. The aim of this study was to determine FMH in the third trimester and at term of pregnancy and to evaluate the role of clinical and ultrasound markers in the prediction of FMH. MATERIALS AND METHODS FMH was quantified by cytofluorimetric testing at 28 to 35 weeks of gestation in 223 women and at term in 465 women, all with risk factors. Foetal evaluation included foetal movement profile, middle cerebral artery peak velocity of systolic blood flow (MCA-PSV) and cardiotocographic monitoring. RESULTS All women tested negative for FMH in the third trimester. Four patients (0.9%) tested positive at term, with estimated volumes of bleeding of 2.2, 8.1, 12.3 and 39.8 mL. Three FMH cases (75%) had a non-reassuring cardiotocography compared to 8.9% (42/461) of women without FMH (p=0.003) and two FMH cases reported a reduction in foetal movements reduction compared to four of those without FMH (p=0.001). Mean MCA-PSV was normal in both the groups with and without FMH (p=0.22). DISCUSSION FMH is rare in pregnancy and at term. Cytofluorimetric testing is a specific method to detect mild-to-moderate FMH even when the MCA-PSV is not informative. Mild-to-moderate FMH is significantly associated with reduced foetal movements and non-reassuring cardiotocographic monitoring.
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9
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Gielezynska A, Stachurska A, Fabijanska-Mitek J, Debska M, Muzyka K, Kraszewska E. Quantitative fetomaternal hemorrhage assessment with the use of five laboratory tests. Int J Lab Hematol 2016; 38:419-25. [DOI: 10.1111/ijlh.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- A. Gielezynska
- Department of Immunohaematology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - A. Stachurska
- Department of Immunohaematology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - J. Fabijanska-Mitek
- Department of Immunohaematology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - M. Debska
- Department of Obstetrics and Gynaecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - K. Muzyka
- Department of Obstetrics and Gynaecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - E. Kraszewska
- Department of Gastroenterology and Hepatology; Centre of Postgraduate Medical Education; Warsaw Poland
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10
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Welsh KJ, Bai Y. Pathology Consultation on Patients With a Large Rh Immune Globulin Dose Requirement. Am J Clin Pathol 2016; 145:744-51. [PMID: 27267375 DOI: 10.1093/ajcp/aqw051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review the differential diagnosis and laboratory issues for women with a large calculated dose of Rh immune globulin (RhIG). METHODS A case-based approach is used to review the differential diagnosis of patients with a large calculated dose of RhIG, RhIG dosing for women with baseline elevations in hemoglobin F, the formulations of RhIG, and issues for the transfusion medicine service with the release of large doses of RhIG. RESULTS A large fetomaternal bleed after delivery requiring multiple doses of RhIG is rare. Such patients may require intravenous RhIG to avoid multiple injections. Patients with a large percentage of circulating fetal RBCs should be evaluated for a disorder of hemoglobin synthesis and, if present, should have quantification of the circulating fetal RBCs by flow cytometry. CONCLUSIONS Accurate laboratory evaluation of women with large fetomaternal bleeds is essential for appropriate RhIG administration.
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Affiliation(s)
- Kerry J Welsh
- From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston
| | - Yu Bai
- From the Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston.
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11
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Stroustrup A, Plafkin C, Tran TA, Savitz DA. Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study. Neonatology 2016; 109:248-54. [PMID: 26859152 PMCID: PMC4893009 DOI: 10.1159/000442082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Annemarie Stroustrup
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y., USA
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12
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Gama SGND, Viellas EF, Schilithz AOC, Theme Filha MM, Carvalho MLD, Gomes KRO, Costa MCO, Carmo Leal MD. Factors associated with caesarean section among primiparous adolescents in Brazil, 2011-2012. CAD SAUDE PUBLICA 2015; 30 Suppl 1:S1-11. [PMID: 25167171 DOI: 10.1590/0102-311x00145513] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022] Open
Abstract
This paper presents the factors associated with caesarean section in primiparous adolescents in Brazil using data from a national hospital-based survey conducted between 2011 and 2012. Information was obtained from postpartum women through face-to-face and telephone interviews and a theoretical model with three levels of hierarchy was used to analyze associations with the dependent variable mode of delivery (caesarean or vaginal). The results show that the caesarean section rate among primiparous teenagers is high (40%). The most significant contributing factors for caesarean section were: considering this mode of delivery safer (OR=7.0; 95%CI: 4.3-11.4); giving birth under the private health system (OR=4.3; 95%CI: 2.3-9.0); being attended by the same health care professional throughout prenatal care and delivery (OR=5.7; 95%CI: 3.3-9.0) and clinical history of risk and complications during pregnancy (OR=10.8; 95%CI: 8.5-13.7). Adolescent pregnancy continues to be an important concern on the reproductive health agenda and the rates observed by this study are worrying given the effects of early exposure to caesarean section.
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Affiliation(s)
| | | | | | | | | | | | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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13
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Urgessa F, Tsegaye A, Gebrehiwot Y, Birhanu A. Assessment of feto-maternal hemorrhage among rhesus D negative pregnant mothers using the kleihauer-betke test (KBT) and flow cytometry (FCM) in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2014; 14:358. [PMID: 25381160 PMCID: PMC4289366 DOI: 10.1186/1471-2393-14-358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/01/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study aimed to assess fetomaternal hemorrhage (FMH) among RhD negative pregnant mothers using two techniques, Kleihauer-Betke (KBT) and Flow cytometry (FCM). To determine if patient-specific doses of prophylactic anti-D warrant further investigation in Ethiopia and wider Africa. METHODS Hospital- based cross-sectional study was conducted among 75 RhD negative pregnant mothers using convenient sampling technique. RESULT FMH has been detected in 52% and 60% by KBT and FCM techniques, respectively. The volume of FMH quantified in the majority of the cases (92.5% and 87%) was <10 mL fetal blood while >30 mL in 1.3% (1/75) and 2.7% (2/75) as calculated by KBT and FCM, respectively. The FMH calculated by the two methods have good correlation; r = 0.828 (p = 0.000) for categorized and r = 0.897 (p = 0.000) for continuous values and the agreement between the FCM and KBT was moderate with kappa (κ) value of 0.53 (p = 0.000). CONCLUSION Most of FMH calculated (<10 mL) could have been neutralized by lower doses which might have lower costs than administering 300 μg dose which is currently in practice in our country for affording mothers. Besides, it also showed that the volume of FMH was >30 mL in 1.3% and 2.7% of the cases as calculated by KBT and FCM, respectively, which need more than 300 μg dose RhIG for neutralization. Further investigation into the cost- effectiveness and scalability of patient- specific dosing of prophylactic anti-D appears warranted.
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Affiliation(s)
- Fekadu Urgessa
- />Department of Medical Laboratory Science, Haramaya University, Harar, Ethiopia
- />Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- />Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yirgu Gebrehiwot
- />Department of Obstetrics and Gynecology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asaye Birhanu
- />Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
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14
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Tiblad E, Westgren M, Pasupathy D, Karlsson A, Wikman AT. Consequences of being Rhesus D immunized during pregnancy and how to optimize new prevention strategies. Acta Obstet Gynecol Scand 2013; 92:1079-85. [DOI: 10.1111/aogs.12193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/03/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Eleonor Tiblad
- Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Dharmintra Pasupathy
- Division of Women's Health; Women's Health Academic Centre; King's Health Partners; King's College London; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Anita Karlsson
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Agneta T. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
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