International Journal of Clinical Case Reports 2017, Vol.7, No.15, 62-66
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The severity of the condition justifies the need for early diagnosis to improve this extremely unfavorable fetal
prognosis. This diagnosis should ideally be made before the rupture of the membranes. It can be done: to the
vaginal touch which recognizes exceptionally the preavia vessels by palpating fibrous, hard, pulsatile cords
circulating in the membranes.
Amnioscopy, which is used less and less, makes it possible to make the diagnosis of certainty of the condition and
thus prevents cases of exsanguination by indicating an extraction with intact membranes. Many cases diagnosed
by amnioscopy and favorable development have been reported.
Giannopoulos (Giannopoulos and Carver, 1987) reported for the first time the ultrasound diagnosis of a preavia
vessel and since this examination was proposed as a diagnostic element. Ultrasound allows the detection of
vessels passing between the presentation and the internal orifice of the neck (Baulies et al., 2007; Carbonnel et al.,
2007; Chmait et al., 2010; Cipriano et al., 2010; Hasegawa et al., 2011). Later it was shown that this method is not
reproducible because of the difficulties of visualizing small diameter vessels buried in the bottom of the pelvis.
This examination should therefore be coupled to the vaginal color doppler to improve the visualization of vascular
flow (Baulies et al., 2007; Cipriano et al., 2010; Hasegawa et al., 2011; Nishtar and Wood, 2012; Ruiter et al.,
2015).
In case of haemorrhage, the diagnosis is based on the detection of fetal hemoglobin. This search must not delay
the extraction decision. Numerous tests have been proposed; In particular that of Kleihauer. Hemoglobin
electrophoresis was also used. The major disadvantage of these two tests is the length of time required for making
a sufficiently long 30 minutes to 1 hour. Some authors (Kazadi, 1991) recommend the APT test or alkaline
denaturation resistance test, it is faster realization, its principle is based on a colorimetric reaction observable with
the naked eye. This test requires a large blood volume (2 to 3 ml) and only in the laboratory, which limits its use.
Currently, other colorimetric tests are reported, all short-circuit centrifugation and workable in a few minutes
(Heckel et al., 1993). The Jones test appears to be the most relevant because of sensitivity and specificity of 100%
(Jones et al., 1987). This test consists of mixing 9 volumes of blood taken at 1% sodium hydroxide in a test tube
or on filter paper, fetal hemoglobin resists alkaline denaturation and the sample retains the red color at reverse
maternal hemoglobin does not resist is the mixture takes in two minutes a brown coloration.
In spite of the progress of neonatal resuscitation, Benckiser's haemorrhage is one of the rare conditions for which
the fetal prognosis remains appalling with a perinatal mortality rate which varies from 75 to 100% of the cases for
the singletons (Heckel et al., 1993; Régis et al., 2006; Aissi et al., 2013) this prognosis would be better for
multiple pregnancies but it remains severe (Heckel et al., 1993).
The therapeutic management of this obstetric emergency must therefore not suffer any delay:
With intact membranes, caesarean section should be performed without delay (Heckel et al., 1993). Attempts
vaginal
delivery while keeping the membranes intact until complete dilatation are prohibited, there is always a
risk of sudden decompensation.
With broken membrane,if the fetus is alive, the caesarean section must be performed urgently. If the fetus is
deceased, the vaginal
delivery is the rule in the absence of obstetrical contraindication. In our observation, the
rapidity of cesarean delivery coupled with intensive neonatal resuscitation was at the origin of a favorable
outcome of the fetus.
3 Conclusions
Benckiser Haemorrhage is a rare condition. Its clinical symptomatology is nonspecific and its diagnosis is often
made only when examining the delivery. Despite the progress of neonatal resuscitation, the fetal prognosis
remains formidable.
