Pelikan, D.M.V.
Citation
Pelikan, D. M. V. (2006, March 23). On fetomaternal hemorrhage. Pasmans Offsetdrukkerij
B.V., Den Haag. Retrieved from https://hdl.handle.net/1887/4347
Version:
Corrected Publisher’s Version
License:
Licence agreement concerning inclusion of doctoral thesis in the
Institutional Repository of the University of Leiden
Downloaded from:
https://hdl.handle.net/1887/4347
4XDQWL¿FDWLRQRIIHWRPDWHUQDOKHPRUUKDJH
DFRPSDUDWLYHVWXG\RIWKHPDQXDODQG
DXWRPDWHGPLFURVFRSLF.OHLKDXHU%HWNHWHVWV
DQGÀRZF\WRPHWU\LQFOLQLFDOVDPSOHV
'HQLVH03HOLNDQ0' 6LFFR$6FKHUMRQ0'3K' :LOPD(0HVNHU *RGHOLHYH0GH*URRW6ZLQJV *HHVNH*%URXZHU0DQGHPD +DQV-7DQNH3K' +XPSKUH\+.DQKDL0'3K'(Am J ObstetGynecol2004;191:551-557)
0DQXDOHYDOXDWLRQRI.OHLKDXHU%HWNHVWDLQHGVOLGHV )HWDOUHGFHOOVZHUHFRXQWHGLQVXEVHTXHQWPLFURVFRSLF¿HOGVXVLQJD[ REMHFWLYH$GXOWUHGEORRGFHOOVFRQWDLQLQJVPDOODPRXQWVRI+E)ZHUH GLVWLQJXLVKHGIURPIHWDOUHGFHOOVE\LQWHQVLW\DQGLQWUDFHOOXODUGLVWULEXWLRQRIWKHSLQN VWDLQLQJ2QO\EULJKWSLQNVWDLQHGFHOOVZHUHFODVVL¿HGDVIHWDO7KHIHWDOUHGFHOO SHUFHQWDJHZDVFDOFXODWHGIURPWKHSURSRUWLRQRIWKHGHWHFWHGQXPEHURIIHWDOUHG FHOOVDQGWKHHVWLPDWHGWRWDOQXPEHURIEDFNJURXQGUHGFHOOVLQ¿HOGV $XWRPDWHGPLFURVFRSLFDQDO\VLVRI.OHLKDXHU%HWNHVWDLQHGVOLGHV $IWHUPDQXDOFRXQWLQJWKHVDPHVOLGHVZHUHHPEHGGHGLQ)OXRURPRXQWHPEHGGLQJ PHGLXP*XUU%'+/LPLWHG3RROH8.DQGVHDOHGZLWKDFRYHUJODVV$QDXWRPDWHG PLFURVFRSH2O\PSXV%;HTXLSSHGZLWKDVFDQQLQJVWDJH0DHU]KDXVHU &R:HW]ODU*HUPDQ\DQGD0'6LPDJHDQDO\VLVV\VWHP$SSOLHG,PDJLQJ &RUSRUDWLRQ6DQWD&ODUD&$ZDVXVHG$WOHDVWORZSRZHU¿HOGV[REMHFWLYH ZHUHVFDQQHGZLWKDWZRVWHS¿OWHUVZLWFKPHWKRGWRLGHQWLI\IHWDOUHGFHOOVE\EULJKW ¿HOGDQDO\VLV$JUHHQ¿OWHUZDVDSSOLHGWRVHOHFWDOOSLQNVWDLQHGFHOOVDQGDUHG¿OWHU WRLGHQWLI\DQGH[FOXGHWKHKHPDWR[\OLQFRXQWHUVWDLQHGZKLWHEORRGFHOOV2SWLPDO VRIWZDUHVHWWLQJVIRUGHWHFWLRQDQGDQDO\VLVZHUHGH¿QHGRQDVHWRIWHVWVDPSOHV $XWRPDWLFDOO\GHWHFWHGFHOOVZHUHVWRUHGLQDGDWDEDVHDQGUHORFDWHGIRUGLUHFW PLFURVFRSLFYHUL¿FDWLRQ2QO\EULJKWSLQNFHOOVZHUHVHOHFWHGDVIHWDO7KHIHWDOUHG FHOOSHUFHQWDJHZDVFDOFXODWHGIURPWKHSURSRUWLRQRIWKHGHWHFWHGQXPEHURIIHWDO UHGFHOOVWRWKHHVWLPDWHGWRWDOQXPEHURIEDFNJURXQGUHGFHOOVDWOHDVW )ORZF\WRPHWU\ 6WDLQLQJSURWRFRO 7KHUHGEORRGFHOO5%&FRXQWRIHDFKSDWLHQWVDPSOHZDVGHWHUPLQHGRQD 6\VPH[.FHOOFRXQWHU%D[WHU6FLHQWL¿F&KLFDJR,/DQGDGMXVWHGWRD¿QDO FRQFHQWUDWLRQRI[/MOZLWK3%6$SSUR[LPDWHO\[UHGFHOOVMOZHUH
'LVWULEXWLRQRIIHWDOFHOOSHUFHQWDJHVEHWZHHQPHWKRGV
PDQXDO.%7DQGDXWRPDWHGPLFURVFRS\,QRQHSDWLHQWGLDJQRVHGZLWKDSODFHQWDO DEUXSWLRQ)&0GHWHFWHGDVXEVWDQWLDOO\KLJKHUIHWDOUHGFHOOSHUFHQWDJHWKDQWKH PDQXDODQGDXWRPDWHG.%7 $JUHHPHQWDQGFRUUHODWLRQEHWZHHQPHWKRGV 7KHFRUUHODWLRQEHWZHHQWKHH[SHFWHGDQGGHWHFWHGIHWDOUHGFHOOSHUFHQWDJH PHDVXUHGLQFRQWUROVDPSOHVE\PDQXDO.%7DXWRPDWHGPLFURVFRS\DQG)&0ZDV JRRGU DQG7KHFRHI¿FLHQWRIYDULDWLRQIRUHDFKPHWKRGVWXGLHG LQUHSOLFDWHGHWHUPLQDWLRQVZDVOHVVWKDQLQWKHPDMRULW\RIFRQWUROVDPSOHV H[FHSWIRUWKHGLOXWLRQWKHFRHI¿FLHQWRIYDULDWLRQZDV&DOFXODWLRQVRI DJUHHPHQWEHWZHHQPHWKRGVLQSDWLHQWVDPSOHVZHUHEDVHGRQWKHUHVXOWVJLYHQ LQWDEOH0RGHUDWHDJUHHPHQWZDVREVHUYHGEHWZHHQDXWRPDWHGPLFURVFRS\DQG WKHPDQXDO.%7ZHLJKWHGK &, $FRPSDULVRQRIWKHIHWDOUHG FHOOSHUFHQWDJHPHDVXUHGE\WKHPDQXDO.%7DQGDXWRPDWHGPLFURVFRS\DIWHUORJ WUDQVIRUPDWLRQLVLOOXVWUDWHGLQ¿JXUHU $JUHHPHQWEHWZHHQ)&0DQGWKH PDQXDO.%7ZDVIDLUZHLJKWHGK &, DQGFRUUHODWLRQUZDV Ta b l e 2 - $FRPSDULVRQRIWKHUHVXOWVIURPPDQXDO.%7DXWRPDWHGPLFURVFRS\DQGÀRZF\WRPHWU\LQ SDWLHQWVDPSOHV DXWRPDWHGPLFURVFRS\ ÀRZF\WRPHWU\ PDQXDO.%7 ! ! ! 13 3 23 total WKHFXWRIIYDOXHIRUDSRVLWLYHÀRZF\WRPHWULFWHVWUHVXOWZDVr Ta b l e 3 - $FRPSDULVRQRIWKHIHWDOUHGFHOOSHUFHQWDJHDQGWKH)0+YROXPHPOPHDVXUHGE\ PDQXDO.%7DXWRPDWHGPLFURVFRS\DQGÀRZF\WRPHWU\LQSDWLHQWVZLWKVXEVWDQWLDO)0+
PDQXDO.%7 DXWPLFURVFRS\ ÀRZF\WRPHWU\
VDPSOH PO PO PO
D i s c u s s i o n
,QWKHSUHVHQWVWXG\ZHTXDQWL¿HG)0+LQDKLJKULVNSDWLHQWJURXSE\PDQXDODQG DXWRPDWHGPLFURVFRSLFDQDO\VHVRI.OHLKDXHU%HWNHVWDLQHGVOLGHVDQGE\)&0 0RGHUDWHDJUHHPHQWZDVIRXQGEHWZHHQWKHPDQXDODQGDXWRPDWHG.%7GXHWRWKH GLIIHUHQFHVEHWZHHQWKHVHPHWKRGVLQWKHVPDOOHUUDQJHVRI)0+)DLUDJUHHPHQW ZDVREVHUYHGEHWZHHQWKHPDQXDO.%7DQG)&0PDLQO\EHFDXVHRIWKHLQVHQVLWLYLW\ RI)&0WRGHWHFW)0+ ,QWKHPDMRULW\RISDWLHQWVD)0+EHWZHHQDQGZDVGHWHFWHG/DUJH )0+ZDVGLDJQRVHGLQKLJKULVNREVWHWULFDOFDVHV,QWKUHHRIWKHVHSDWLHQWVZLWK )0+UDQJLQJIURPWRTXDQWL¿FDWLRQZDVDOPRVWLGHQWLFDOZLWKWKHWKUHH PHWKRGV,QRQHSDWLHQW)&0GHWHFWHGD)0+RIZKLOHERWKWKHPDQXDODQG Figure 1 - $OLQHDULW\VWXG\RIWKHIHWDOFHOOSHUFHQWDJHPHDVXUHGE\PDQXDO.%7DQGDXWRPDWHG PLFURVFRS\LQSDWLHQWVDPSOHVORJ\ ORJ[U 7KH]HURYDOXHV ZHUHWUDQVIRUPHGWRIRUWKHSXUSRVHRIDORJDULWKPLFH[SUHVVLRQfetal red cell percentage detected by manual KBT
DXWRPDWHG.%7UHVXOWHGLQ7KHLPSODXVLEOHKLJKOHYHORI)0+DVHVWLPDWHGE\ )&0PD\EHH[SODLQHGE\DKLJKPDWHUQDO)FHOOSHUFHQWDJHZKLFKFRXOGQRWEH GLVFULPLQDWHGIURPWKHIHWDOFHOOSRSXODWLRQOHDGLQJWRDQRYHUHVWLPDWLRQE\)&0 ,QDUHFHQWSXEOLFDWLRQRQWKHUHODWLRQEHWZHHQWKLUGWULPHVWHUEOHHGLQJDQGWKH RFFXUUHQFHRI)0+!PHDVXUHGE\WKH.%7QRVLJQL¿FDQWLQFUHDVHRI)0+ ZDVIRXQGFRPSDUHGWRQRQFRPSOLFDWHGSUHJQDQFLHV$)0+!ZDVIRXQG LQRXWRIFDVHVZLWKYDJLQDOEOHHGLQJ,QRXUVWXG\ZHGHWHFWHGD)0+EHWZHHQ DQGE\PDQXDODQGDXWRPDWHG.%7LQRXWRISUHJQDQFLHV FRPSOLFDWHGE\YDJLQDOEOHHGLQJZLWKRXWVLJQVRISODFHQWDODEUXSWLRQ9DJLQDO EOHHGLQJGXHWRSODFHQWDODEUXSWLRQZDVGLDJQRVHGLQSDWLHQWV2QHRIWKHVH SDWLHQWVKDGDVXEVWDQWLDO)0+DQGLQWKHRWKHUWZRSDWLHQWVDYHU\VPDOO)0+ZDV GHWHFWHG 2YHUWKHSDVW\HDUVDODUJHSURSRUWLRQRIWKHKRVSLWDOVKDYHDEDQGRQHGWKH WUDGLWLRQDO.%7DQGQRZXVHÀRZF\WRPHWULFDVVD\VIRUWKHTXDQWL¿FDWLRQRI)0+ 7KLVFKDQJHLVGXHWRSUHVXPHGXQUHOLDELOLW\RIWKH.%7PDLQO\DVDFRQVHTXHQFHRI PRGL¿FDWLRQVRIWKHWHVWDQGDQDO\VLVRIDQLQVXI¿FLHQWQXPEHURIPLFURVFRSLF¿HOGV OHDGLQJWRODUJHLQWHUREVHUYHUDQGLQWHUODERUDWRU\YDULDELOLW\11,123XEOLFDWLRQVRQ WKHSHUIRUPDQFHRI)&0XVLQJDQWL+E)RUDQWL'KDYHVKRZQWKDW)&0LVFDSDEOH RITXDQWLI\LQJRQO\)0+rZLWKDFFXUDF\7KHUHODWLRQEHWZHHQWKH PDQXDO.%7DQGÀRZF\WRPHWULFDVVD\VVWURQJO\GHSHQGVRQWKH.%7PHWKRGXVHG %RWKXQGHUHVWLPDWLRQDQGRYHUHVWLPDWLRQRIWKHIHWDOFHOOSHUFHQWDJHE\WKH