Significant fetal-maternal hemorrhage after termination of pregnancy: Implications for development of fetal cell microchimerism

doi:10.1067/mob.2001.111072

American Journal of Obstetrics and Gynecology

Volume 184, Issue 4, March 2001, Pages 703-706

https://doi.org/10.1067/mob.2001.111072 Get rights and content

Abstract

Objective: Recent reports that an association exists between fetal cell microchimerism and autoimmune disease has increased interest in the postpartum persistence of fetal cells. The purpose of this study was to determine, by means of quantitative polymerase chain reaction amplification, whether a significant fetalmaternal hemorrhage occurs after elective termination of pregnancy. Study Design: Blood samples were obtained from 23 women who underwent termination of pregnancy immediately before venipuncture; these samples were subjected to analysis by quantitative polymerase chain reaction amplification with the use of Y-chromosome primers. There were 21 male and 2 female fetuses. Results were equilibrated to 16 mL and analyzed by a weighted linear regression analysis to evaluate the correlation between detected fetal nucleated cell equivalents and gestational weeks. Results: Among the 21 known male fetuses, the median number of detected fetal nucleated cell equivalents was 1552 (range, 50-37,618). The female fetuses had no fetal nucleated cell equivalents detected. A positive dependence of male fetal nucleated cell equivalents on gestational age was shown (P <.001). Conclusion: Analysis by quantitative polymerase chain reaction amplification demonstrated a large fetal-maternal transfusion after elective abortion. Consideration of the biologic consequences of pregnancy and the potential for future development of fetal cell microchimerism must now extend to a larger population of women. (Am J Obstet Gynecol 2001;184:703-6.)

Section snippets

Subjects

Peripheral venous blood samples (6.5-15.5 mL) were obtained in ethylenediaminetetraacetic acid (EDTA) from 23 women undergoing elective abortion by means of an institutionally approved human subjects protocol. Pregnancy histories were unavailable from study subjects, although the majority of women were undergoing termination because of unwanted pregnancy. To the best of our knowledge, the study subjects had not previously undergone invasive prenatal genetic testing, such as amniocentesis or

Results

Of the 23 samples, there were 2 known female fetuses, and both had no cells detected. Quantitative PCR analysis of the 21 known male samples normalized to 16 mL showed between 50 and 37,618 fetal nucleated cell equivalents detected (median, 1552 fetal nucleated cell equivalents).

A weighted linear regression analysis, which was based on the number of cases available at each gestational week, was performed in 21 cases with a known male fetus. A statistically significant dependence of the values

Comment

In this study we used quantitative PCR amplification of a Y chromosome–specific sequence to measure the number of male fetal nucleated cell equivalents present in the peripheral blood of women who had recently undergone an elective termination of pregnancy. The results demonstrate a significant fetal-maternal transfusion of cells, even after a first-trimester termination procedure. The median number of male fetal nucleated cell equivalents detected in a 16-mL blood sample was 1552. This

Acknowledgements

We thank J. Lee Nelson for her review of the manuscript and Michelle Genova for her laboratory technical expertise.

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^☆: Supported by a grant from Genzyme Genetics to the New England Medical Center.

^☆☆: Reprint requests: Diana W. Bianchi, MD, Chief, Division of Genetics, New England Medical Center, Box 394, 750 Washington St, Boston, MA 02111.

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Fetus-Placenta-NewbornSignificant fetal-maternal hemorrhage after termination of pregnancy: Implications for development of fetal cell microchimerism☆,☆☆

Abstract

Section snippets

Subjects

Results

Comment

Acknowledgements

Obstet Gynecol

Lancet

Am J Hum Genet

Am J Obstet Gynecol

Mol Cell Probes

Fetal leukocytes in the maternal circulation after delivery. I. Cytological aspects

Transplantation

Survie de lymphocytes foetaux dans le sang maternal post-partum

Schweiz Med Wochenschr

Fetus-Placenta-Newborn
Significant fetal-maternal hemorrhage after termination of pregnancy: Implications for development of fetal cell microchimerism☆,☆☆