title: Flowcytometric assessment of fetomaternal hemorrhage during external cephalic version at term.
abstract: External cephalic version (ECV) at term is a safe procedure and reduces the incidence of cesarean sections for breech presentation. One of the known complications, however, is an ECV-related disruption of the placental barrier and a subsequent transfusion of fetal blood into maternal circulation. While the incidence of ECV-related fetomaternal hemorrhage (FMH) has been determined recently in a large trial using a manual Kleihauer-Betke test (KBT), questions remain on the amount of ECV-related FMH. KBT, which detects fetal red blood cells (RBC) on the basis of acidic resistance of fetal hemoglobin (HbF), is known to be a sensitive test, yet prone to procedural errors limiting its accuracy in quantifying FMH. In this study we investigated 50 patients for FMH before and after ECV, using a dual-color flow cytometric test kit with a lower limit of quantification of 0.05% fetal RBC in maternal peripheral blood. Three patients had a quantifiable increase of fetal RBC detected after ECV (0.06%; 0.08%; 0.1%). None of these subtle increments was predictable by ECV-related clinical parameters or translated into fetal compromise. Using a sensitive and accurate flow cytometric test method, our data provide further assurance to mothers on the safety of ECV at term.
authors.affiliation: Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholz
authors.forename: Andrea
authors.initials: A
authors.lastname: Kachler
authors.forename: Christine
authors.initials: C
authors.lastname: Hermann
authors.forename: Tobias
authors.initials: T
authors.lastname: Weissenbacher
authors.forename: Bettina
authors.initials: B
authors.lastname: Toth
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
authors.forename: Franz
authors.initials: F
authors.lastname: Kainer
mesh_terms: D004906:Erythrocyte Count; D005260:Female; D005331:Fetomaternal Transfusion / Q000209:etiology*; D005434:Flow Cytometry; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D014710:Version, Fetal / Q000009:adverse effects*