ABSTRACT
Fetomaternal hemorrhage (FMH) syndrome refers to a group of symptoms, including fetal anemia and maternal hemolytic transfusion reaction caused by fetal blood entering the maternal circulation through intervillous space. Diagnosis of FMH can be easily missed due to its non-specific symptoms and may lead to high perinatal mortality. The degree of fetal anemia and the volume of blood loss can be clinically evaluated by ultrasound measurement of middle cerebral artery peak systolic velocity and Kleihauer-Betke test. Clinical management is based on the degree of fetal anemia and gestational age. Intrauterine blood transfusion and termination are standard management. Fetal-maternal transfusion over 20 ml/kg is associated with fetal/neonatal morbidity or mortality. The incidence of FMH in twin pregnancy is rarely reported. We here report a case of dichorionic diamniotic twin pregnancy. Intrauterine death occurred to one of the twins because of FMH, and the other fetus was delivered at term with good outcome based on close monitoring.