Fetomaternal Hemorrhage

Abstract

Fetomaternal hemorrhage refers to the entry of fetal blood into the maternal circulation before or during delivery. Antenatal fetomaternal hemorrhage is a pathological condition with a wide spectrum of clinical variation. Secondary to the resultant anemia, fetomaternal hemorrhage may have devastating consequences for the fetus such as neurologic injury, stillbirth, or neonatal death. Presentation is frequently without an evident precipitating factor. Recognition may become apparent only after injury has occurred, if at all. The most common antenatal presentation is decreased fetal activity and a heightened index of suspicion is warranted in cases of persistent maternal perception of decreased fetal movements. The diagnostic standard, the Kleihauer-Betke screen, has several limitations. Management remains challenging. When detected antenatally, cordocentesis with intrauterine transfusion may be attempted to correct the anemia; however, repeat intrauterine transfusion or delivery may be necessitated to correct ongoing bleeding. Although the occurrence of large antenatal fetomaternal hemorrhage is fortunately rare, this entity likely remains underreported and underrecognized. A national registry should be created to advance our learning across institutions by reviewing the clinical presentations of fetomaternal hemorrhage, the variety of fetal heart rate tracings observed, the management strategies undertaken, and the outcomes achieved.

Evaluation of FMH QuikQuant for the detection and quantification of fetomaternal hemorrhage

“…Dim pink cells were considered as adult F cells. KBT were reported as positive when the count of fetal RBCs were higher than 8 per 10,000 adult cells (2,20).…”

“…The amount of fetal red blood cells (RBCs) in the maternal circulation determines the therapeutic dose of anti-RhD immunoglobulin necessary to prevent allo-immunization and FMH occurrence (1). Besides, FMH testing contributes to the management of severe situations such as decreased fetal activity, neonatal anemia, or unexplained stillbirth (2).…”

Síndrome de transfusión feto-materna

“…(7) En cuanto a la etiología, el 75% es de causa desconocida y en la mayoría de casos no existe un desencadenante evidente (8). De las posibles causas destacan los traumatismos abdominales (accidentes, caídas, VCE), anomalías placentarias y de cordón (desprendimiento prematuro de placenta normoinserta, trombosis de la vena umbilical, inserción velamentosa, coriocarcinoma…) y procedimientos invasivos (amniocentesis, biopsia corial, cordocentesis)(3).…”

Placental Parameters and Foetomaternal Haemorrhage

“…10 Wylie and D'Alton have opined that there is unexplained FMH in 80% of cases with volume < 30 mL. 11 They have proposed a theory of disruption of trophoblast, in which the foetal circulation is at higher pressure which pushes the foetal red blood cells into maternal circulation which explains FMH of greater than 30 mL in majority of unexplained cases.…”