Appropriate testing for fetomaternal haemorrhage (FMH) is critical in the prevention of morbidity and mortality due to haemolytic disease of the fetus and newborn (HDFN) in RhD negative women. The Kleihauer or acid elution (AE) test is widely used to assess the size of fetomaternal haemorrhage and to determine whether sufficient Anti-D immunoglobulin has been administered to prevent HDFN. This test is based on the principle that adult haemoglobin (HbA) is eluted from red cells in an acidic solution while the fetal haemoglobin (HbF) is not. However, in the presence of an elevated level of HbF of maternal origin, the AE test may be “positive” in the absence of a true FMH. We report two cases in which this situation arose antenatally, leading to difficulties in clinical interpretation. In both cases, specialised flow cytometry revealed the presence of elevated levels of HbF of maternal origin. While awaiting completion of specialised investigations, Anti-D was administered but was later found to have been unnecessary. Early awareness of the possibility of elevated maternal F cells ensures that samples can be sent to appropriate reference laboratories early to limit unnecessary Anti-D administration. The true prevalence of “false positive” AE tests due to elevated maternal HbF is unknown and is the subject of ongoing work in our laboratory, but should be considered in the differential diagnosis of an AE test remaining positive despite appropriate Anti-D administration.

3rd and 4th degree tears occur in 1% of vaginal deliveries. In the Rotunda the rate in the first six months of 2012 was increased at 3%. The aim of this audit was to assess compliance with current Rotunda guidelines and where non-compliance was identified assess if complications arose as a result. A retrospective chart review of all third and fourth degree tears was performed. There were 51 cases during this time period and 47 charts were available for review. The comparison standard was the Rotunda Hospitals “Guidelines for Management of Episiotomy and Repair of Perineal Trauma” Sept 2010. There were 51 cases in total. 45% were following Spontaneous vertex delivery, 27% following ventouse delivery, 14% following combination of ventouse and forceps and 14% forceps alone. 100% were repaired under regional anaesthesia. Only 66% received the correct dose and duration of antibiotics. 95% received laxatives post delivery with only 51% received appropriate non-opiate analgesia. 44.6% of patients were reviewed by senior staff and 81% received physiotherapy. 87% were followed up in the perineal clinic. Review of current perineal repair form should be performed to include headings more specific to third/fourth degree tears. A sticker highlighting that the patient has had a third/fourth degree tear should be placed on the front of drug Kardex. This may help avoid prescription of opiate analgesia. All women receive an information leaflet on discharge. Women should have senior staff review day 1 postpartum. It should be re-audited in six months.