Is the incidence of fetal-to-maternal hemorrhage increased in patients with third-trimester bleeding?

Objective: If a pregnancy is complicated by third-trimester bleeding, is there a higher risk of fetal-to-maternal hemorrhage that might necessitate the administration of additional anti-D immune globulin to prevent alloimmunization in the patient who is Rh D-negative? The study objective was to analyze prospectively the incidence of fetal-to-maternal hemorrhage in pregnancies that were complicated by third trimester bleeding compared with three control groups.

Study Design: Pregnancies that were complicated by third-trimester bleeding, preterm premature rupture of the membranes, and preterm labor were identified prospectively on admission. A group of preterm patients with no complications was also collected prospectively. Patients with any history and/or clinical evidence of trauma were excluded. Kleihauer-Betke tests were performed with all patients, and the results were blinded until study completion. Sample size calculations were performed to determine the minimum number of cases needed in each group.

Results: A total of 403 patients were collected during the study period: 91 patients had third-trimester bleeding, 101 patients had preterm premature rupture of the membranes, 116 patients had preterm labor, and 95 patients were in the no complication group. There was no statistical difference identified in the Kleihauer-Betke test results between any of the study groups.

Conclusion: The incidence of fetal-to-maternal hemorrhage does not appear to be increased in pregnancies that are complicated by third-trimester bleeding when compared to noncomplicated control subjects or to other obstetrically complicated pregnancies. This information would suggest that the routine administration of additional anti-D immune globulin (beyond the current recommended protocol) to women who are Rh D-negative whose pregnancies are complicated by third-trimester bleeding is not indicated.