Pregnancy bleeding during second and third trimester: Is the Kleihauer-Betke test really useful?

Area of Science:

• Perinatal Hemobiology
• Maternal-Fetal Medicine

Background:

• Bleeding during the second and third trimesters of pregnancy requires careful evaluation.
• The Kleihauer test is used to detect fetal-maternal hemorrhage.

Purpose of the Study:

• To assess the clinical utility of the Kleihauer test in pregnant women experiencing bleeding in the second and third trimesters.
• To determine the rate of positive Kleihauer tests and their association with maternal and neonatal outcomes.

Main Methods:

• Retrospective single-center study of pregnant women with bleeding (15-42 weeks gestation).
• Analysis of clinical data, ultrasound findings, Kleihauer test results, and neonatal outcomes.
• Review of Kleihauer test data from a National Reference Center for Perinatal Hemobiology (CNRHP).

Main Results:

• The Kleihauer test was performed in 36.5% of cases, with no positive results.
• No significant abnormalities were found in fetal heart rate monitoring or Doppler ultrasound.
• 4.4% of newborns had mild anemia, none requiring intensive care or transfusion.
• At the CNRHP, only 0.5% of Kleihauer tests for bleeding were positive, with no associated adverse outcomes.

Conclusions:

• Systematic use of the Kleihauer test for bleeding in late pregnancy appears to have limited clinical value.
• Further research is needed to optimize guidelines for managing bleeding in pregnant women.
• Current evidence suggests the test may not significantly impact clinical management or neonatal outcomes in these cases.