Fetomaternal hemorrhage complicated pregnancy

Abstract

There is an urgent need for the internationally accepted definition, standardized pregnancy management protocol, and structured follow-up of neonates from such pregnancies. We suggest the international registry of massive FMH cases.

Massive Fetomaternal Hemorrhage Remote from Term: Favorable Outcome after Fetal Resuscitation and Conservative Management

“…Because of its variable onset and presentation, the prognosis is poor, including a high risk for fetal hydrops progressing to stillbirth, hypoxic-ischemic encephalopathy, premature delivery of a compromised infant at high risk for neonatal anemia, and death. Standardized diagnostic and treatment criteria of FMH are not established, and the definition of massive FMH ranges from transfusion requirements of > 20 or > 30 mL to > 80 mL/kg of fetal weight [7]. The present case highlights all of the challenges in the diagnosis and initial management of this condition as well as the difficulties it poses for ongoing pregnancy supervision.…”

Síndrome de Transfusión Feto-Materna. A propósito de dos casos.

“…Esta transfusión ocurre en la mayoría de los casos sin factores de riesgo identificables, y en promedio no superaría los 15 ml de sangre, permaneciendo en su gran mayoría clínicamente asintomáticas 5,6 . Se estima que una transfusión fetomaterna sería significativa cuando supera los 30 ml de sangre.…”

“…Dada la gravedad potencial del cuadro, es importante el diagnóstico precoz para establecer el tratamiento oportuno, el cual, dependiendo de la edad gestacional, incluye desde la transfusión fetal in útero hasta la interrupción inmediata del embarazo 5 . Una herramienta diagnóstica fundamental orientada a la detección de la anemia fetal como consecuencia de la transfusión feto-materna es la ultrasonografía doppler obstétrica, la cual permite obtener una estimación bastante precisa de la magnitud de las repercusiones fetales por la anemia secundaria.…”

The Recurrence Risk of Fetomaternal Hemorrhage

“…NST can show nonspecific patterns of decelerations. Sinusoidal pattern clearly indicates that fetal anemia must be suspected and managed [12, 13]. Middle cerebral artery peak systolic velocity (MCA-PSV) Doppler measurement may have a role in the evaluation and monitoring of suspected fetal anemia [14-16].…”

“…The detection of fetal cells in the maternal blood is necessary for the confirmation of FMH. The most widely used test remains the Kleihauer-Betke test; another methods are flow cytometry and liquid chromatography [12]. …”