Massive fetomaternal hemorrhage: a case series and review of literature

Abstract

Objectives Massive fetomaternal hemorrhage (FMH) is a rare and difficult to diagnose event that can have catastrophic outcomes. Although many etiologies have been associated with FMH, the majority of cases are idiopathic and affect uncomplicated pregnancies. The prevailing symptom is decreased fetal movements but some cases are asymptomatic. Changes in the fetal Doppler ultrasound, a sinusoidal cardiotocographic pattern, neonatal anemia, unexplained hydrops or stillbirth can raise suspicion that such an event has occurred. Case presentation This article presents a case series of severe FMH diagnosed in our center between 2011 and 2020 as well as a review of the current available literature. Conclusions We highlight the importance of the clinician’s awareness on detecting this rare but potentially life-threatening event.

Is Feto-Maternal Transfusion after Cesarean Delivery Different in Singleton and Twin Pregnancy?

“…The authors found a similar incidence of large FMH in singleton and multiple pregnancies [ 25 ]. Moreover, several case reports presented different outcomes [ 2 , 3 , 12 , 26 , 27 , 28 ]. In all the abovementioned published studies, the incidence of a significant FMH was analyzed.…”

“…As a result of placental barrier interruption, the fetal red blood cells can cross into the maternal circulation [ 2 , 3 , 4 ]. If the mother’s immune system is stimulated by fetal red blood cell antigens, antibodies are produced, which may lead to the development of hemolytic disease of the fetus (HDF).…”

Red Blood Cell Alloimmunization in Pregnancy: A Review of the Pathophysiology, Prevalence, and Risk Factors

“…A common complication of RBC alloimmunization in pregnant women is FMH, which may have devastating consequences to the fetus such as fetal demise, neurologic injury, hydrops, delivery of a severely anaemic infant and stillbirth [41][42][43]. There are more than 60 different RBC antigens, which are commonly referred to as alloimmunization, especially the Rhesus, Kell, Duffy, Kidd, and MNS blood group systems [38].…”