Fetomaternal hemorrhage (FMH), an update: review of literature and an illustrative case

Maier, Jutta; Schalinski, E; Schneider, W; Gottschalk, U; Hellmeyer, L

doi:10.1007/s00404-015-3686-1

Cited by 33 publications

(28 citation statements)

References 24 publications

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“…A decreased perception of fetal movements [7][8][9][10][11][12] and abnormal cardiotocography (CTG) [3,10] are usually present. More recently, increased peak velocities in the middle cerebral arteries (MCA-PSV) detected by Doppler ultrasound have been described [8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] .…”

Section: Objectivesmentioning

confidence: 99%

Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

et al. 2016

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Objectives: To analyze the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetomaternal hemorrhage (FMH) and to compare it with standard biophysical assessment. Data Sources: Retrospective review of cases of FMH seen in our unit and systematic review of the literature. Results: We followed the MOOSE guidelines to review the literature. From 838 articles, 16 were selected. In total, 35 women, including 3 cases from our center and 32 obtained from the literature search were included. Diagnosis of FMH was always confirmed by laboratory tests. Patients were seen at 31 ± 5 weeks' gestation (range 16-39) and the most frequent indication for referral was decreased perception of fetal movements. Cardiotocography (CTG) upon admission was sinusoidal in 18 cases, nonreactive in 6, decelerative in 2 and tachycardic in one. MCA-PSV was abnormal in all cases but one. There were 2 perinatal deaths. The mean hemoglobin concentration at birth or at intrauterine transfusion was 4.8 ± 1.9 g/dl. Discussion: The most accurate predictor of FMH was fetal MCA-PSV. CTG was always abnormal but the pattern was frequently nonspecific. We suggest including fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.

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Section: Objectivesmentioning

confidence: 99%

Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

et al. 2016

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“…Fetomaternal hemorrhage refers to the entry of fetal blood into the maternal circulation before or during labor . The occurrence of massive fetomaternal hemorrhage is rare; however, the loss of high blood volumes from fetuses may result in various fetal conditions, ranging from cardiovascular distress to death.…”

Section: Introductionmentioning

confidence: 99%

“…The occurrence of massive fetomaternal hemorrhage is rare; however, the loss of high blood volumes from fetuses may result in various fetal conditions, ranging from cardiovascular distress to death. Thus, the early detection of the symptoms and signs of potential fetomaternal hemorrhage is critical in order to take appropriate action to prevent further harm to the fetus and mother in cases of fetomaternal hemorrhage . However, the symptoms of fetomaternal hemorrhage are highly nonspecific and include neonatal anemia, followed by decreased or absent fetal movement as well as stillbirth .…”

Section: Introductionmentioning

confidence: 99%

Cardiotocography findings of early‐stage chronic fetomaternal hemorrhage after the presentation of reduced fetal movement

Haruna

Suzuki

2019

Clinical Case Reports

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Key Clinical Message In the current case of fetomaternal hemorrhage with reduced fetal movements, the findings of cardiotocography (CTG) seemed to be indicating reassuring fetal status; however, a late deceleration and sinusoidal heart rate (SHR)‐like findings were observed following a weak uterine contraction. Altogether, this case indicates that the presence of reduced fetal movements may precede the appearance of SHR patterns on CTG in cases of chronic fetomaternal hemorrhage.

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“…Early detection of FMH is critical [10]. Clinical examination, nonstress test (NST), and routine ultrasonography are often ineffective.…”

Section: Introductionmentioning

confidence: 99%

“…Nearly half of the cases of massive FMH are only diagnosed in the early neonatal period or present as fetal death, but precise estimates of adverse outcomes are unknown [10]. …”

Section: Introductionmentioning

confidence: 99%

The Recurrence Risk of Fetomaternal Hemorrhage

et al. 2018

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Massive fetomaternal hemorrhage (FMH) can cause devastating pregnancy outcomes. Perinatal prognosis may be improved by intrauterine transfusion, but the appropriate management for these pregnancies remains unclear. To determine the recurrence risk of FMH after intrauterine transfusion, we performed a systematic review of all case reports/series of patients with proven FMH treated with intrauterine transfusion and who had subsequent follow-up of at least 72 h until delivery. This revealed 13 cases, with 1 additional case from our institution. Ten patients (71.4%) had a second episode of FMH requiring a second intrauterine transfusion. Five patients (35.7%) required at least 3 intrauterine transfusions. The time interval between intrauterine transfusions was progressively reduced. The gestational age at the onset of signs/symptoms was 26.6 ± 2.1 weeks, and gestational age at delivery was 34.2 ± 4.2 weeks. Two cases of fetal demise (14.3%) and no neonatal deaths were recorded. Limited postnatal follow-up on 8 neonates was normal. The mean neonatal hemoglobin and transfusion rates were 13.2 ± 5.7 g/dL and 33.3%, respectively. Close fetal monitoring, likely daily, is necessary to recognize FMH recurrence. Several transfusions may be necessary once FMH is diagnosed if pregnancy is allowed to continue > 72 h.

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Fetomaternal hemorrhage (FMH), an update: review of literature and an illustrative case

Cited by 33 publications

References 24 publications

Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review

Cardiotocography findings of early‐stage chronic fetomaternal hemorrhage after the presentation of reduced fetal movement

The Recurrence Risk of Fetomaternal Hemorrhage

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