Association Between Maternal Serum Level of Alpha-Fetoprotein and Fetomaternal Hemorrhage in High Risk Pregnant Women

Abstract

Background: Fetomaternal hemorrhage is considered to be a grave complication which may occur during pregnancy. And due to its graveness the fetomatenal hemorrhage renders the pregnancy as a high risk condition, so it must be diagnosed, followed and managed properly in order to avoid any hazards on the mother and the fetus. The Alpha-Fetoprotein is the major protein component of fetal serum which is synthesized by the visceral endoderm of the yolk sac during early fetal life and subsequently by the fetal liver. Aims: To find an easier and cheaper test for detection and quantification of FMH, with less inter- and intra- observer variation than the standard KBT. Methodology: Study type: Diagnostic Test accuracy study. Study place: In Maternity Hospital at Ain Sham University Hospitals in the period from August 2015 to February 2016, samples were analysed at clinical pathology department at Ain Shams University. Results: The required sample size had been calculated using the Power Analysis and Sample Size software version 11.0.10 (PASS; NCSS, LLC, Kaysville, Utah). The primary outcome measure is the accuracy of alpha-fetoprotein for diagnosis of significant fetomaternal hemorrhage. A previous study reported that the incidence of significant feto-maternal hemorrhage was of the order of 29%. Conclusion: Our study showed that around 22% of high risk deliveries have a FMH more than 4 ml which require an extra dose of anti D. And thanks GOD that the high incidence of ABO incompatibility might protect against sensitization but this incidence should certainly ring a bell and raise interest concerning the hazards and bad impact of underestimating the amount of FMH in those populations. Recommendations: Preoperative sampling for KBT should be done to avoid false +ve results by KBT in patients with persistent Hb F. Exclusion of fetomaternal ABO incompatibility, which yields false –ve KBT. Keywords: Maternal Serum Level, Alpha-Fetoprotein, Fetomaternal Hemorrhage, High Risk Pregnant Women