Role of Kleihauer test in Rhesus negative pregnancy

To determine the role of Kleihauer test in estimating fetomaternal haemorrhage and dose of injection anti-D.

Analytical study.

MCH Center, Unit-II, PIMS, Islamabad, from February to December 2004.

A hundred Rhesus negative pregnant women delivered after 28 weeks gestation during the study period were studied. The main outcome measures were Kleihauer test estimation of fetomaternal haemorrhage and association of significant fetomaternal haemorrhage with antepartum haemorrhage (APH), amniocentesis, twin delivery, intrauterine death (IUD), external cephalic version (ECV), manual removal of placenta and cesarean section.

Among the hundred women, 28 were primigravidae while 72 were multigravidae. Mean gestational age at delivery was 38.4+/-1.6 weeks. In 24% Rhesus-D negative subjects, potential sensitizing events occurred antenatally. In 11% of these, events occurred before 24 weeks of gestation. Two percent underwent ECV, 10 % had blunt abdominal trauma in third trimester while one patient had APH. Sixty five women had vaginal delivery and cesarean section was performed in 35. Outcome was alive baby in all cases except one intrauterine fetal demise (IUD). Four patients had placenta removed manually. Mean amount of fetomaternal haemorrhage was 2.7+/-1.01 ml (1.2-5.2 ml). The mean anti-D dose required was 67.3+/-25.3 microg. Twenty six women did not need anti-D as they had Rhesus negative infants.

In this series routine postnatal Rhesus prophylaxis with 300 microg anti-D immunoglobulin covered all the feto-maternal haemorrhage. Therefore, Kleihauer test with added burden of cost is not indicated as a routine to rhesus negative women.