Feto-maternal haemorrhage: a review after and a case report

Feto-maternal haemorrhage is the transmission of fetal blood cells to the maternal blood stream. It is quite common in small volumes- occurring in most pregnancies. Large volumes of feto-maternal haemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is most important clinical sign, together with a pathological NST. Prompt diagnosis and immediate obstetric care is fundamental, as serious risk to the fetus might result from this condition. Author described the case report of 35 years old G3P1L1A1 with 37 weeks 5 days pregnancy, who came in outpatient department with reduced perception of fetal movements during the previous 10 hours. There was no history of abdominal trauma. Cardiotocograph showed nonreactive NST with minimal beat to beat variability for more than 40minutes. An emergency caesarean section was performed and a female limp baby delivered with heart rate <60/minutes, pale, no respiration and no reflexes. Baby resuscitated with bag and tube ventilated. APGAR score was 3/5/6 at 0, 1, and 5 minutes. Fetal haemoglobin at the first hour of life was 3.0gm/dl. Kleihauer-Betke test revealed 265.7ml of fetal erythrocytes in the maternal blood stream. Despite being rare, it is important to detect a massive feto-maternal haemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as feto-maternal haemorrhage is a rare but potentially catastrophic event for a fetus.

Anemia neonatal grave secundaria a transfusion feto-materna: a proposito de un caso / Severe neonatal anemia due to fetomaternal hemorrhage: an ilustrative case

La transfusión feto-materna es el paso de eritrocitos fetales a la circulación materna. Cuando es masiva, tiene una incidencia aproximada del 0,2-0,9 %. Generalmente, se desconoce el agente desencadenante, pero, en ocasiones, se pueden identificar factores de riesgo. En el embarazo, suele ser asintomática; el síntoma más frecuente es la disminución de los movimientos fetales (el 26 %) en relación con la anemia grave. Se diagnostica mediante la detección de hemoglobina fetal en la sangre materna (test de Kleihauer o citometría de flujo). Se presenta a un recién nacido con anemia crónica secundaria a la transfusión fetomaterna, que, después del tratamiento con transfusión de concentrado de hematíes, tuvo como complicación síntomas de sobrecarga de volumen y empeoramiento clínico. Tras la realización de una exanguinotransfusión, evolucionó favorablemente, sin secuelas.

Fetomaternal transfusion (FMT) is defined by the transfer of fetal blood into the maternal circulation. The incidence of massive FMT is estimated to be approximately 0.2-0.9 % of births. Although a number of etiologies have been associated with FMT, most causes remain unidentified and the pregnancy is usually asymptomatic. The most frequent symptom is the decrease in fetal movements (26 %) in relation to severe anemia. Several diagnostic modalities for FMT are described (Kleihauer stain, flow cytometry). We describe a case of a newborn with chronic anemia secondary to FMT who, after treatment with transfusions of red blood cells, presented volume overload and clinical worsening as a complication. In this case, our patient needed exchange transfusion for definitive improvement without disability.

Massive Fetomaternal Hemorrhage.

Massive fetomaternal hemorrhage (FMH) is a rare entity and the diagnosis needs to be determined by performing a Kleihauer- Betke test (KBT) of the maternal blood. We present a case of massive FMH presenting as severe neonatal anemia. The varied presentations of FMH and its management are discussed.

Two Cases of Severe Neonatal Anemia associated with Massive Feto-Maternal Hemorrhage / 대한주산의학회잡지

Feto-maternal hemorrhage, the presence of fetal red blood cells in the maternal circulation, occurs in up to 75% of pregnancies. But its volume is usually very small. Feto-maternal hemorrhage of more than 30 ml of whole blood is relatively rare. The key features that lead to early diagnosis are the maternal history, fetal monitoring, the clinical and laboratory findings of anemia and a negative Coombs' test. Diagnosis is confirmed by Kleihauer-Betke test. Perinatal problems include fetal distress, neonatal anemia, hypovolemic shock, and death. The fetal outcome depends on the amount and rate of bleeding. The initial hemoglobin level was a better predictor than the volume of bleeding. We present two cases of severe neonatal anemia associated with massive feto-maternal hemorrhage, which was confirmed by Kleihauer-Betke test.