Accessible Requires Authentication Published by De Gruyter March 17, 2009

Flowcytometric assessment of fetomaternal hemorrhage during external cephalic version at term

Christoph Scholz, Andrea Kachler, Christine Hermann, Tobias Weissenbacher, Bettina Toth, Klaus Friese and Franz Kainer
From the journal


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.

Corresponding author: Prof. Dr. Franz Kainer, MD Department of Obstetrics and Gynecology Ludwig-Maximilians University Maistraße 11 80337 Munich Germany Tel.: +49-89-5160-4111 Fax: +49-89-5160-4516

Received: 2008-9-9
Revised: 2008-11-24
Accepted: 2008-11-27
Published Online: 2009-03-17
Published Online: 2009-03-17
Published in Print: 2009-07-01

©2009 by Walter de Gruyter Berlin New York