Massive Fetomaternal Hemorrhage

Abstract

This report describes a full-term newborn with massive fetomaternal hemorrhage. Fetal movements were decreased 48 hr prior to delivery. On the day of delivery, they were absent. The nonstress test was abnormal with low biophysical profile and decreased beat-to-beat variability. The infant presented with extreme pallor, hypotonia, hepatosplenomegaly, and ascites. The initial hemoglobin was 2.2 g/dL, the Kleihauer-Betke stain was 27.6% (highest level ever reported). Right temporal and cerebellar hemorrhages were present. Sequelae include severe developmental delay and asymmetric double hemiplegia.

Abnormal Nonstress Test yet Otherwise Reassuring Biophysical Profile in a Compromised Fetus with Severe Antepartum Intracranial Hemorrhage

“…Interpretation of the absence of such variables is enhanced if they had been present previously [1]. In the only previously reported case regarding the BPP in a fetus with an intracranial hemorrhage (right temporal and cerebellar), the BPP was 2/10 (points awarded for fluid only) [5]. Our case suggests that in the presence of central nervous abnormality or significant hemorrhage, normal ultrasonographic BPP parameters may not always indicate a reassuring fetal status.…”

“…Although the fetal BPP is most commonly applied as an outpatient prenatal testing modality, utilization of this noninvasive test in acute clinical settings in nonlaboring patients has been reported [4][5][6]. We present an unusual case in which a patient presenting for fetal testing due to suspected fetal growth restriction exhibited a concerning nonreactive nonstress test with a concurrent fetal BPP assessment revealing active fetal tone, movements, breathing movements and amniotic fluid volume.…”

Non‐invasive diagnosis by Doppler ultrasonography of fetal anemia due to massive fetomaternal hemorrhage in a case of twin–twin transfusion syndrome treated with serial amnioreduction

“…Current evidence suggests that either 200 mg or 600 mg mifepristone followed 36 to 48 hours later with 400 µg of oral misoprostol or 800 µg of vaginal misoprostol are effective for abortion at up to 49 days' gestation. Mifepristone affects not only a woman's reproductive system, but her cardiovascular, digestive and central nervous systems as well 2 . Patients who opt to have medical abortion should be counseled about the side effects of this combination regimen.…”

Fetomaternal Hemorrhage: Mostly a Hidden Hazard

“…At this cutoff, the incidence of FMH has been estimated to be approximately 3 per 1,000 births [1,2]. Other investigations have defined severe FMH as transplacental transfer of fetal blood of ≥150 ml, and at this cutoff the incidence is approximately 1 in 3,000 births [3,6,7]. Rates of perinatal mortality associated with severe FMH range from 10 to 50% [2,3,7].…”

“…Other investigations have defined severe FMH as transplacental transfer of fetal blood of ≥150 ml, and at this cutoff the incidence is approximately 1 in 3,000 births [3,6,7]. Rates of perinatal mortality associated with severe FMH range from 10 to 50% [2,3,7]. This wide range is not surprising due to the variations in definitions of severe FMH.…”