Sinusoidal Heart Rate Patterns as a Manifestation of Massive Fetomaternal Hemorrhage in a Monochorionic-Diamniotic Twin Pregnancy: A Case Report

Abstract

Objective: A case of fetomaternal hemorrhage (FMH) in monochorionic twins is reported. Method: Case report. Result: The patient felt a decrease in fetal movements at 32 gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in both fetuses. The fetal hemoglobin level in maternal blood was 6.6% (normal 0.0–1.0%). Since the patient was diagnosed with massive FMH, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both infants, based on red blood cell count, hemoglobin concentration, and hematocrit of 86 × 10 and 85 × 10⁴/mm³ (normal 376–456 × 10⁴/mm³), 3.1 g/dl each (normal 10.9–13.5 g/dl), and 10.7 and 10.4% (normal 32.2–41.2%), respectively. Severe anemia may develop in both fetuses following massive FMH in monochorionic twins. As such, if abnormal circulation is detected in 1 monochorionic twin, the other fetus will also require special attention.

Acute Fetomaternal Hemorrhage Confirmed by Maternal Alfa-Fetoprotein in Monochorionic Diamniotic Neonates under 1,500 g

“…Only two reports have been identified 19,20) as known; hence, FMH occurrence in very low birth weight monochorionic diamniotic twin pregnancy is quite rare and may be the first case in Korea.…”

Placental Pathologic Features in Fetomaternal Hemorrhage Detected By Flow Cytometry

“…1,3 Recognized causes of FMH include placental anomalies such as placental tumors, like chorangioma [9][10][11][12] and choriocarcinoma, 11,[13][14][15][16][17] placental abruption, 18,19 and umbilical cord anomalies 18 as well as twin pregnancy. 20,21 FMH has also been described after maternal trauma 22 and obstetric procedures such as external cephalic version, 23,24 amniocentesis, 25,26 chorionic villous sampling, 26 and cordocentesis. 27 However, it has been estimated that a cause is not found in greater than 80% of patients with FMHs of at least 30 mL.…”