Prospective quantification of fetomaternal hemorrhage with dilation and evacuation procedures.
Contraception
; 99(5): 281-284, 2019 05.
Article
em En
| MEDLINE
| ID: mdl-30500335
ABSTRACT
OBJECTIVE:
To describe fetomaternal hemorrhage (FMH) during second-trimester dilation and evacuation (D&E) to evaluate if Rhesus-immune globulin (RhIG) 100 mcg (used in the United Kingdom) and 300 mcg (used in the United States) provide adequate prophylaxis. STUDYDESIGN:
We conducted an exploratory prospective descriptive study of women undergoing D&E between 15â¯weeks 0â¯days and 23â¯weeks 6â¯days of gestation. Enrolled participants had Kleihauer-Betke testing on specimens obtained before and after D&E. We assessed the main outcome measures of FMH in mL suggesting need for more than 100 mcg and 300 mcg RhIG (FMH of 10â¯mL and 30â¯mL fetal whole blood, respectively) and association of postprocedure FMH with demographic characteristics and procedure-related variables.RESULTS:
The 300 participants had a mean gestational age of 19â¯weeks 6â¯days±2â¯weeks 2â¯days. The median preprocedure FMH was 0â¯mL (range 0-50â¯mL) with 2 (0.67%) women exceeding 10â¯mL (19â¯mL and 50â¯mL). The median postprocedure FMH was 1â¯mL (range 0-60â¯mL). Almost all participants had postprocedure FMH <10â¯mL (n=295, 98.3%) and <30â¯mL (n=298, 99.3%). All participants under 18â¯weeks had FMH <10â¯mL. We found no demographic or procedure-related factors to be predictive of FMH quantity.CONCLUSIONS:
FMH occurring with routine second-trimester D&E procedures is minimal. Adequate prophylaxis with RhIG 100 mcg and 300 mcg occurred in >98% of women and in all cases <18â¯weeks of gestation. This study is the first step to potentially reducing the dose and costs of RhIG administration with D&E. IMPLICATIONS This study is a first step in quantifying fetomaternal hemorrhage with routine dilation and evacuation procedures; larger trials are needed, especially to understand why some women have recognizable hemorrhage preprocedure. If dosing requirements are too high with current guidelines, lower doses will result in resource and cost savings.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Isoimunização Rh
/
Imunoglobulina rho(D)
/
Dilatação e Curetagem
/
Transfusão Feto-Materna
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Contraception
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos