Özet:

Amaç   Amniocentesis and cordocentesis are invasive procedures used in prenatal diagnosis and treatment generally, including Rh-aloimmunized pregnancies. However, these methods can cause considerable fetal-maternal hemorrhage (FMH), worsening of the existing, or appearing of the new aloimmunization. Our aim was to compare the frequency and amount of the FMH after amniocentesis or cordocentesis; evaluate if transplacental approach increases the risk for the appearance of FMH; and show the significance of the results in the treatment of the Rh-aloimmunized pregnancies. Yöntem   We studied 61 pregnant women who underwent invasive prenatal diagnostic procedures. The presence of "irregular" antibodies was not registered in any of the pregnancies, no matter to their D-antigen status (Rh-positive or Rh-negative). Amniocentesis was done in 33, while cordocentesis in 28 cases. Anamnestic data of previous bleeding and invasive procedures in two months period were registered. After each intervention we registered if placenta was penetrated. We preferred extraplacental approach. For the detection of FMH, Kleihauer-Braun-Betke "acid elusion test" (KBBT) was used in mother blood samples taken immediately before and 1 hour after the intervention. Bulgular All pregnant women were older than 35 years. Average gestation was smaller in amniocentesis subgroup. Before the intervention we registered FMH in only one case of amniocentesis (1.6%). Amount of FMH was 0.05ml and didn't change after the intervention. We considered this FMH "silent" because there was no data of previous bleeding or invasive procedures. Previous bleeding was noted in 7, while invasive procedures were done in 12 cases, but FMH wasn't registered before the intervention in any of these cases. We registered new FMH in 2 cases after amniocentesis and 8 after cordocentesis (6.1: 28.6%) which shows statistical difference. After the cordocentesis we found higher mean FMH volume, more frequent severe FMH (> 5ml of fetal blood), increased percentual loss of total fetal-placental blood volume. FMH is more frequent following the transplacental approach (27.8%) comparing with the extraplacental (11.6%), but there is no statistical difference. During the cordocentesis FMH is more frequent following transplacental approach (33.3%: 23.1%), but there is no statistical difference. Two largest quantities of FMH were found in two cases of cordocentesis in which we punctured through placenta twice. Sonuç Cordocentesis is a method with increased risk for the worsening of the preexisting or the appearance of the new aloimmunizataion comparing with the amniocentesis. Therefore in Rh-aloimmunizated pregnancy cordocentesis is justified under the suspicion of severe anemia and the need for FIVT. Clinical significance of the KBBT is to individualize the anti-D-immune globulin immune-prophylactic dose; after the cordocentesis in D-negative nonimmunized mother, KBBT should be done, and if necessary, increase the dose of Rhlg.

Anahtar Kelimeler: