PLACENTAL PARAMETERS AS DETERMINANTS OF FETO-MATERNAL HAEMORRHAGE IN PARTURIENTS

Abstract

BACKGROUND: Fetomaternal haemorrhage takes place across the placenta
in normal pregnancies without identifiable risk factors and as well as when
there are obstetric interventions or trauma related complications of pregnancy.
This loss of fetal blood into maternal circulation would stimulate antibody
production in the Rh D Negative pregnant woman who is carrying a Rh D
positive baby and lead to dire consequences in subsequent pregnancies.
OBJECTIVE: This is to evaluate whether placental parameters (weight,
volume, thickness and grade) at term could be used as predictors of
fetomaternal haemorrhage in parturients.
MATERIALS AND METHODS: In all consenting parturients, baseline bio
data, maternal blood group, Rh D status, mode of delivery and other obstetric
interventions were recorded. Obstetric ultrasound was done at 36 – 38 weeks
for booked parturients and in labour for unbooked parturients to assess
placental thickness and grade. Maternal blood sample and cord blood were
taken at delivery. Maternal blood sample was tested for fetal blood cells using
Kleihauer – Betke test. The FMH was calculated using Mollison’s formula.
Baby blood group and Rhesus status was determined from the cord blood.
The placentae of these parturients were collected, washed under running
water, trimmed and its weight and volume were measured. Data generated
were analyzed with Statistical Package for Social Scientists (SPSS) version
17 software. Level of statistical significance was set at p < 0.05.
RESULTS: A total of 150 parturients were studied. There were no significant
differences in maternal age, parity, estimated gestational age, baby birth
weight and maternal blood group in both groups of parturients with and
without fetomaternal haemorrhage. A total of 52 parturients (34.7%) had
demonstrable fetomaternal haemorrhage. Large FMH were noted in 2
parturients (1.4%) out of the 52 with demonstrable FMH.
The mean placental weight was 516.89g ± 41.84, mean placental volume was
506.51mls ± 41.97, and mean placental thickness on USS was 21.44mm
±1.47.
None of the placental parameters [placental weight (p = 0.893); placental
volume (p = 0.666); placental thickness (p = 0.361); and placental grade (p =
0.585)] showed any significant difference in both groups with and without
FMH.
CONCLUSION: Placental parameters did not prove to be predictive of FMH
and the null hypothesis is upheld. In all Rh D Negative parturients with Rh D
Positive babies, Kleihauer- Betke test should be done to determine volume of
fetal bleed and appropriate dose of anti- D immunoglobulin should be
administered. There is need for further multi-centre and multi-racial studies to
establish determinants and risk factors of FMH and the role(s) of the placenta
in this regard.

PLACENTAL PARAMETERS AS DETERMINANTS OF FETO-MATERNAL HAEMORRHAGE IN PARTURIENTS