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Liao S, Zhao J, Li T, Yi T, Lin X, Bian C, Ling C. Massive fetomaternal hemorrhage in a monochorionic-diamniotic twin pregnancy: a case report. J Matern Fetal Neonatal Med 2023; 36:2197096. [PMID: 37045601 DOI: 10.1080/14767058.2023.2197096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Fetomaternal hemorrhage (FMH) result into severe, life-threatening fetal anemia and cause intrauterine death of the fetus. It is tough for an early diagnosis of FMH before pregnancy and few authors reported FMH in a twin pregnancy. Therefore, we reported a case of massive FMH. The patient felt a decrease in fetal movements at 33+5 gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in one fetus. The fetal hemoglobin level in maternal blood was 6.4% (normal range for single pregnancy, 0.0%-2.0%). Since the patient was diagnosed with fetal distress, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both neonates, based on red blood cell count, hemoglobin concentration, and hematocrit of 0.75 × 1012/L and 0.61 × 1012/L, 2.8 g/dL and 2.4 g/dL, and 10.0% and 8.4%, respectively. The neonates were admitted to the intensive care unit for prematurity care and presently are well. In our experience, an early diagnosis of FMH contributed to saving fetus. Obstetricians should highlight fetal movements counting to every patient. Once massive FMH occurs in monochorionic twins, both fetuses may develop severe anemia and require emergency intervention.
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Affiliation(s)
- Shuying Liao
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Jitong Zhao
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Tao Yi
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Xiaojuan Lin
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ce Bian
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Chen Ling
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
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Smet C, Queiró L, Santos E, Reis A, Costa C. Massive fetomaternal hemorrhage: a case series and review of literature. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Carolina Smet
- Obstetricts and Gynecology Department , Hospital de São Francisco Xavier – Centro Hospitalar Lisboa Ocidental , Lisboa , Portugal
| | - Luísa Queiró
- Neonatal Intensive Care Unit, Pediatrics Department , Hospital de São Francisco Xavier – Centro Hospitalar Lisboa Ocidental , Lisboa , Portugal
| | - Edmundo Santos
- Neonatal Intensive Care Unit, Pediatrics Department , Hospital de São Francisco Xavier – Centro Hospitalar Lisboa Ocidental , Lisboa , Portugal
| | - Ana Reis
- Clinical Pathology Department , Hospital de São Francisco Xavier – Centro Hospitalar Lisboa Ocidental , Lisboa , Portugal
| | - Cristina Costa
- Obstetricts and Gynecology Department , Hospital de São Francisco Xavier – Centro Hospitalar Lisboa Ocidental , Lisboa , Portugal
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3
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Diagnostic accuracy of Kleihauer-Betke (Kb) testing to predict fetal outcomes associated with fetomaternal hemorrhage: a retrospective cohort study. J Perinatol 2022; 42:91-96. [PMID: 34408259 DOI: 10.1038/s41372-021-01185-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the diagnostic and screening utility of Kleihauer-Betke (KB) testing as a triage tool in predicting adverse fetal outcomes associated with fetomaternal hemorrhage (FMH). STUDY DESIGN Single center retrospective cohort study evaluated a primary composite outcome of fetal complications associated with FMH between KB-negative and KB-positive test groups. Screening tests for sensitivity, specificity, positive predictive value and negative predictive value were determined. RESULTS 641 women (97%) had KB-negative and 22 (3%) had KB-positive tests. The primary composite outcome between KB-negative and KB-positive pregnancies was similar (30% vs. 36%, p = 0.54). Screening exhibited high specificity (97%), however, test sensitivity was poor (4%) with only moderate positive and negative predictive values (36.4 and 69.7%). CONCLUSION Fetal outcomes associated with FMH were not significantly different between KB-positive and KB-negative test cohorts; KB testing offers no diagnostic precision in the emergency triage evaluation of women with suspected FMH.
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Ficarola F, Svelato A, Angioli R, Rossi R, D'Avino S, DE Luca C, Rinaldo D, Ragusa A. Reduced fetal movements: the case of Fetomaternal Hemorrhage. Case series and proposal of a management protocol. Minerva Obstet Gynecol 2021; 74:386-392. [PMID: 34904586 DOI: 10.23736/s2724-606x.21.04972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fetomaternal hemorrhage (FMH) was reported more than 60 years ago for the first time defined by the transfer or transfusion of fetal blood into the maternal circulation before or during delivery. The transfused volume is usually very small but when this value exceeds, it may be clinically significant. Antenatal diagnosis of severe FMH is difficult and it can be suspected in case of reduction of fetal movements, abnormal cardiotocography and ultrasound. FMH is associated to different adverse outcomes and admission to neonatal intensive care. The low incidence of FMH limits the studies, thus being able to rely only on diagnosis and retrospective studies. We present case series of FMH and analyze the steps with the purpose of defining a flow-chart for early diagnosis and management of FMH.
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Affiliation(s)
- Fernando Ficarola
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy -
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Policlinico Campus Bio-Medico, Rome, Italy
| | - Rita Rossi
- Department of Obstetrics and Gynecology, Massa Carrara General Hospital, Massa Carrara, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Caterina DE Luca
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Denise Rinaldo
- Department of Obstetrics and Gynecology, Bolognini General Hospital, Seriate, Bergamo, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
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5
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Gică N, Botezatu R, Demetrian M, Vayna AM, Cimpoca-Raptis BA, Ciobanu AM, Gica C, Peltecu G, Panaitescu AM. Severe Neonatal Anemia Due to Spontaneous Massive Fetomaternal Hemorrhage at Term: An Illustrative Case with Suspected Antenatal Diagnosis and Brief Review of Current Knowledge. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1285. [PMID: 34946230 PMCID: PMC8704460 DOI: 10.3390/medicina57121285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Fetomaternal hemorrhage is defined as transfer of fetal blood into placental circulation and therefore into maternal circulation during pregnancy, and represents an important contributor to intrauterine fetal demise and neonatal death. The condition is rarely diagnosed prenatally because clinical findings are often nonspecific, and it is unpredictable. In this paper we present an illustrative case of massive spontaneous fetomaternal hemorrhage where the diagnosis was highly suspected antenatally based on maternal reported reduced fetal movements, abnormal suggestive cardiotocographic trace, and increased peak systolic velocity in the fetal middle cerebral artery. We discuss obstetrical and neonatal management and review the current knowledge in the literature. Maintaining a high index of suspicion for this condition allows the obstetrician to plan for adequate diagnostic tests, arrange intrauterine treatment or delivery, and prepare the neonatal team.
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Affiliation(s)
- Nicolae Gică
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Radu Botezatu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Mihaela Demetrian
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Ana Maria Vayna
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Brîndușa Ana Cimpoca-Raptis
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Anca Marina Ciobanu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Corina Gica
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Gheorghe Peltecu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
| | - Anca Maria Panaitescu
- Carol Davila Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (R.B.); (B.A.C.-R.); (A.M.C.); (C.G.); (G.P.)
- Filantropia Clinical Hospital, 011171 Bucharest, Romania; (M.D.); (A.M.V.)
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Song S, Zhu Y, Jorch G, Zhang X, Wu Y, Chen W, Gong H, Zhou L, Wang X, Zhong X. A very preterm infant born to mother of mirror syndrome secondary to fetomaternal hemorrhage: a case report. BMC Pregnancy Childbirth 2021; 21:701. [PMID: 34663239 PMCID: PMC8522257 DOI: 10.1186/s12884-021-04179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mirror syndrome (MS) is defined as maternal edema with fetal hydrops and placental edema with different etiologies, such as rhesus isoimmunization and twin-twin transfusion syndrome. Herein, we showcased a unique MS case secondary to fetomaternal hemorrhage (FMH). Case presentation A 32-year-old gravida 2 para 0 woman diagnosed with fetal hydrops was admitted to our hospital. Maternal laboratory tests revealed anemia, slightly increased creatinine and uric acid levels, hypoproteinemia, and significantly increased alpha-fetoprotein and hemoglobin-F levels. Therefore, FMH was diagnosed initially. Two days after admission, the woman had unexpectedly progressive anasarca and started to feel chest distress, palpitations, lethargy, and oliguria, and MS was suspected. An emergency cesarean section was performed to terminate the pregnancy. The maternal clinical symptoms and laboratory tests rapidly improved after delivery. A very preterm infant with a 2080-g birthweight at 31 weeks gestation survived after emergency cesarean section, active resuscitation, emergency blood transfusion, abdominocentesis, and advanced life support. Conclusions FMH could develop into MS, providing new insights into the etiology of MS. Once MS is diagnosed, emergency cesarean section might be an alternative treatment. The very preterm infant survived with a favorable long-term outcome, and a well-trained perinatal work team is needed for such cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04179-5.
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Affiliation(s)
- Sijie Song
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Yefang Zhu
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Gerhard Jorch
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China.,Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany
| | - Xiaoting Zhang
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Yan Wu
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Wen Chen
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Hua Gong
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Ligang Zhou
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China
| | - Xueyan Wang
- Department of Obstetrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaoyun Zhong
- Department of Neonatology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, China.
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7
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Sagawa K, Suzuki S. Fetomaternal hemorrhage occurred in one fetus of dichorionic twin pregnancy. Clin Case Rep 2021; 9:e04330. [PMID: 34084530 PMCID: PMC8142297 DOI: 10.1002/ccr3.4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
In a twin pregnancy, it may be difficult to notice the decreased fetal movements, which is one of the main symptoms of fetomaternal hemorrhage, in one fetus due to the movements of the other fetus.
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Affiliation(s)
- Kei Sagawa
- Department of Obstetrics and GynecologyJapanese Red Cross Katsushika Maternity HospitalTokyoJapan
| | - Shunji Suzuki
- Department of Obstetrics and GynecologyJapanese Red Cross Katsushika Maternity HospitalTokyoJapan
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8
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Yoo C, Han S, Jeong H, Heo JS, Lee HS, Jeon J. Acute Fetomaternal Hemorrhage Confirmed by Maternal Alfa-Fetoprotein in Monochorionic Diamniotic Neonates under 1,500 g. NEONATAL MEDICINE 2020. [DOI: 10.5385/nm.2020.27.4.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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Tao E, Ye D, Long G, Hu Y, Fu Q, Yuan T, Jiang M. Severe neonatal anemia affected by massive fetomaternal hemorrhage: a single-center retrospective observational study. J Matern Fetal Neonatal Med 2020; 35:3972-3978. [PMID: 33183095 DOI: 10.1080/14767058.2020.1845313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Massive fetomaternal hemorrhage (FMH) is a rare but sometimes life-threatening event, and surviving neonates may suffer major neurological complications. Severe neonatal anemia (SNA) affected by massive FMH is less reported in the literature. This study aims to explore the clinical characteristics, laboratory diagnoses, treatments and outcomes of SNA affected by massive FMH. METHODS Data were collected retrospectively from the hospital's electronic medical record system. All neonates born in the hospital and admitted to the neonatal unit diagnosed as SNA affected by massive FMH from 1 January 2013 to 31 June 2017 were included. RESULTS A total of 8 cases of SNA affected by FMH were identified among 6825 neonates admitted to the neonatal unit. They all presented with pallor but without hydrops at birth. Median gestational age and birthweight were 375/7 (360/7‒401/7) weeks and 2,625 (2300‒3050) g, respectively. Median hemoglobin level was 39.5 (25‒53) g/L at birth and 109.5 (94-127) g/L at discharge. Median maternal serum alpha-fetoprotein (AFP) was 3958.5 (1606‒14,330) ng/mL, which was significantly increased. Three out of eight cases manifested as antenatal decreased fetal movement. Only 1 with the lowest initial hemoglobin 25 g/L manifested as characteristic sinusoidal fetal heart rate tracing and suffered severe neonatal asphyxia and hypovolemic shock. Having experienced resuscitation, he was admitted to the neonatal unit and received twice transfusion of cross-matched red blood cells there. Another case with the initial hemoglobin 45 g/L received positive pressure ventilation and once transfusion. All cases were successfully discharged with a median hospital stay of 8 (5-12) days. Follow-up was available for 6 (75%) of 8 neonates (age range 13 months to 50 months), and all infants were observed to be in good condition with normal neurological status. In our series of eight cases, there were no neonatal deaths. CONCLUSION This study strengthens the idea that maternal AFP testing is valuable to confirm massive fetomaternal hemorrhage. Surviving neonates of massive FMH might have a good outcome despite severe anemia at birth.
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Affiliation(s)
- Enfu Tao
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, China
| | - Diya Ye
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Gao Long
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuting Hu
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qibo Fu
- Office of National Clinical Research Center for Child Health, Childrens Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tianming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Mizu Jiang
- Department of Gastrointestinal Lab, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Department of Gastroenterology, Children's Hospital, Zhejiang Universiy School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
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10
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Zhang Z, Ge J, Gong Z, Chen J, Wang C, Sun Y. Evaluation of machine learning-driven automated Kleihauer-Betke counting: A method comparison study. Int J Lab Hematol 2020; 43:372-377. [PMID: 33151041 DOI: 10.1111/ijlh.13380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Kleihauer-Betke (KB) test is the diagnostic standard for the quantification of fetomaternal hemorrhage (FMH). Manual analysis of KB slides suffers from inter-observer and inter-laboratory variability and low efficiency. Flow cytometry provides accurate quantification of FMH with high efficiency but is not available in all hospitals or at all times. We have developed an automated KB counting system that uses machine learning to identify and distinguish fetal and maternal red blood cells (RBCs). In this study, we aimed to evaluate and compare the accuracy, precision, and efficiency of the automated KB counting system with manual KB counting and flow cytometry. METHODS The ratio of fetal RBCs of the same blood sample was quantified by manual KB counting, automated KB counting, and flow cytometry, respectively. Forty patients were enrolled in this comparison study. RESULTS Comparing the automated KB counting system with flow cytometry, the mean bias in measuring the ratio of fetal RBCs was 0.0048%, with limits of agreement ranging from -0.22% to 0.23%. Using flow cytometry results as a benchmark, results of automated KB counting were more accurate than those from manual counting, with a lower mean bias and narrower limits of agreement. The precision of automated KB counting was higher than that of manual KB counting (intraclass correlation coefficient 0.996 vs 0.79). The efficiency of automated KB counting was 200 times that of manual counting by the certified technologists. CONCLUSION Automated KB counting provides accurate and precise FMH quantification results with high efficiency.
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Affiliation(s)
- Zhuoran Zhang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Ji Ge
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Zheng Gong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Jun Chen
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Chen Wang
- Lab Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Division of Hematology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada.,Department of Computer Science, University of Toronto, Toronto, ON, Canada
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11
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Abstract
BACKGROUND Any maternal history of blood loss, ABO or Rh incompatibility, and hydrops fetalis often leads to suspicion of neonatal anemia postnatally. When maternal history consists only of decreased fetal movement, recognition of neonatal anemia can be problematic. CLINICAL FINDINGS This case was a transported late preterm neonate who presented initially with persistent hypoxia unresponsive to usual respiratory support. On examination, mild paleness was noted. PRIMARY DIAGNOSIS Anemia caused by fetal-maternal hemorrhage was the ultimate diagnosis confirmed by a Kleihauer-Betke test on maternal serum examining fetal cells. INTERVENTIONS Neonatal resuscitation included positive pressure ventilation, oxygen, and intubation. However, oxygenation did not improve prompting consultation with the neonatologist. Sedation and a paralytic were given. A chest radiograph ruled out pneumothoraces and pleural effusions as causative. Initiation of inhaled nitric oxide produced a mild response. Eventually, the transport nurse obtained a complete blood count indicating severe anemia, which prompted an emergent blood transfusion. The accepting neonatology team consulted with the obstetrician and a Kleihauer-Betke test was performed on mother's blood confirming a large fetal-maternal hemorrhage. OUTCOMES This neonate responded well to blood transfusions, a pressor, and respiratory support and was discharged home at 7 days of life. PRACTICE RECOMMENDATIONS Recognition of postnatal anemia is vital to sustaining life and this can occur in the transport environment. When maternal history is nonspecific and a neonate is hypoxic, uncommon causes of hypoxia can be identified with consultation and a complete blood count.
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12
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van der Knoop BJ, van der Voorn JP, Nikkels PGJ, Zonnenberg IA, van Weissenbruch MM, Vermeulen RJ, de Vries JIP. Placental Histology After Minor Trauma in Pregnancy: A Pilot Study. Pediatr Dev Pathol 2019; 22:221-228. [PMID: 30208758 PMCID: PMC6604405 DOI: 10.1177/1093526618799292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Trauma in pregnancy may cause placental abruption. Consequences of moderate placental injury on neurodevelopment are unknown. The aim was to evaluate placental histology after maternal trauma. METHODS A prospective study was conducted at 2 tertiary medical centers in the Netherlands. Placentas from women exposed to maternal trauma ≥ 20 weeks' gestational age were histologically examined. Neurological follow-up of the infants was performed at 1 year of age by means of Alberta Infant Motor Scale. Histological findings were compared to placentas from pregnancies without trauma. PRINCIPAL RESULTS Thirteen placentas were investigated in the trauma group. The control group consisted of 15 placentas. Placental pathology was seen more often in the trauma cases (11 of the 13) than in the controls (6 of the 15), P = .024. Neurological follow-up was normal. CONCLUSIONS In this small population, majority of the placentas showed pathology after minor trauma in pregnancy without consequences for neurodevelopment at 1 year.
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Affiliation(s)
- BJ van der Knoop
- Department of Obstetrics and
Gynaecology, VU University Medical Center, Amsterdam, the Netherlands,BJ van der Knoop, Department of Obstetrics
and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam,
the Netherlands.
| | - JP van der Voorn
- Department of Pathology, VU University
Medical Center, Amsterdam, the Netherlands
| | - PGJ Nikkels
- Department of Pathology, University
Medical Center Utrecht, Utrecht, the Netherlands
| | - IA Zonnenberg
- Department of Neonatology, VU University
Medical Center, Amsterdam, the Netherlands
| | - MM van Weissenbruch
- Department of Neonatology, VU University
Medical Center, Amsterdam, the Netherlands
| | - RJ Vermeulen
- Department of Child Neurology, VU
University Medical Center, Amsterdam, the Netherlands
| | - JIP de Vries
- Department of Obstetrics and
Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
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13
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Haruna Y, Suzuki S. Cardiotocography findings of early-stage chronic fetomaternal hemorrhage after the presentation of reduced fetal movement. Clin Case Rep 2019; 7:564-567. [PMID: 30899495 PMCID: PMC6406220 DOI: 10.1002/ccr3.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/02/2019] [Accepted: 01/26/2019] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Yuria Haruna
- Department of Obstetrics and GynecologyJapanese Red Cross Katsushika Maternity HospitalTokyoJapan
| | - Shunji Suzuki
- Department of Obstetrics and GynecologyJapanese Red Cross Katsushika Maternity HospitalTokyoJapan
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Piva I, Iannone P, Morano D, Greco P. Untimely diagnosis of fetomaternal hemorrhage: what went wrong? J Perinat Med 2018; 47:61-67. [PMID: 30052523 DOI: 10.1515/jpm-2017-0344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 05/07/2018] [Indexed: 11/15/2022]
Abstract
Fetomaternal hemorrhage (FMH) is an obstetrical challenge. It is defined as a passage of fetal blood into the maternal circulation or vice versa, which might complicate pregnancy or delivery. Most cases of acute and chronic FMH are idiopathic in origin and involve uncomplicated near-term pregnancies. Yet, due to the lack of universal screening, heterogeneous clinical presentation and insufficient clinicians awareness, in some cases FMH may present as immediate fetal compromise or even stillbirth as the most devastating consequence. We made a review of the literature of the FMH clinical cases of fetal/neonatal death in order to focus on the available diagnostic tools and their limitations. Cardiotocography, biophysical profile, middle cerebral artery peak systolic volume and current laboratory tests were studied and evaluated as diagnostic tools for FMH. International guidelines are needed to help clinicians make a prompt identification of FMH. Moreover, a standardized management protocol is essential in order to improve fetal-neonatal outcomes.
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Affiliation(s)
- Isabella Piva
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
| | - Piergiorgio Iannone
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
| | - Danila Morano
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
| | - Pantaleo Greco
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy
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Gijtenbeek M, Lopriore E, Steggerda SJ, Te Pas AB, Oepkes D, Haak MC. Persistent pulmonary hypertension of the newborn after fetomaternal hemorrhage. Transfusion 2018; 58:2819-2824. [PMID: 30315664 DOI: 10.1111/trf.14932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018. First, we evaluated the incidence of PPHN and short-term neurologic injury. Second, we studied the potential effect of intrauterine transfusion (IUT). RESULTS PPHN occurred in 37.9% of newborns (11 of 29), respectively, 14.3% (one of seven) and 45.5% (10 of 22) in the IUT group and no-IUT group (p = 0.20). The mortality rate was 13.8% (4 of 29). Severe brain injury occurred in 34.5% (10 of 29), respectively, and 14.3% (one of seven) and 40.9% (nine of 22) in the IUT group and no-IUT group (p = 0.37). CONCLUSION Awareness should be raised among perinatologists and neonatologists about the possible life-threatening consequences of FMH, as more than one-third of neonates with anemia due to FMH experience PPHN and suffer from severe brain injury. Antenatal treatment with IUT seems to reduce these risks. Specialists should therefore always consider fetal anemia in FMH cases and refer patients to a fetal therapy center. If anemia is present at birth, it should be corrected promptly and neonatologists should be aware of signs of PPHN.
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Affiliation(s)
- Manon Gijtenbeek
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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Troìa L, Al-Kouatly HB, McCurdy R, Konchak PS, Weiner S, Berghella V. The Recurrence Risk of Fetomaternal Hemorrhage. Fetal Diagn Ther 2018; 45:1-12. [PMID: 30223274 DOI: 10.1159/000491788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Libera Troìa
- Obstetrics and Gynecology Unit, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rebekah McCurdy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter S Konchak
- Department of Obstetrics and Gynecology, Inspira Medical Center, Vineland, New Jersey, USA
| | - Stuart Weiner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania,
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