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Weinhold V, Rauber S, Hollatz-Galuschki E, Seybold M, Kainer F, Kouskouti C. Massive fetomaternal hemorrhage: A case report. Z Geburtshilfe Neonatol 2024; 228:382-385. [PMID: 38286411 DOI: 10.1055/a-2238-3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
We present a case with an incidental finding of abnormal cardiotocography (CTG) pattern as well as elevated middle cerebral artery peak systolic velocity (MCA-PSV) in an otherwise inconspicuous pregnancy. Massive fetomaternal hemorrhage (FMH) was detected as the cause by flow cytometry (FC), resulting in multiple cycles of fetal blood sampling (FBS) showing severe anemia, intrauterine transfusions (IUTs), a preterm delivery, and a healthy infant in follow-up examinations.
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Affiliation(s)
- Victoria Weinhold
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
| | - Susanne Rauber
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
| | | | - Michael Seybold
- Neonatologie und Pädiatrische Intensivmedizin, Cnopf'schen Kinderklinik, Nürnberg, Germany
| | - Franz Kainer
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
| | - Christina Kouskouti
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany
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Zheng Y, Li D, Li X, Zheng A, Wang F. Spontaneous massive fetomaternal hemorrhage: two case reports and a literature review of placental pathology. BMC Pregnancy Childbirth 2023; 23:530. [PMID: 37480031 PMCID: PMC10360317 DOI: 10.1186/s12884-023-05826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Massive fetomaternal hemorrhage (FMH) is a rare event during pregnancy that may cause severe fetal anemia or death. CASE PRESENTATION This paper reports two cases of fetomaternal hemorrhage with unexplained reasons. Both cases required emergency caesarean sections for non-reassuring fetal status and were treated with neonatal blood transfusion. Fetomaternal hemorrhage was confirmed via maternal Kleihauer-Betke test. CONCLUSION We found parenchymal pallor, increased nucleated red blood cells (nRBCs), and syncytial knots (SKs) in the placentas, which are compatible with fetal anemia. Immunohistochemical staining indicated VEGF, CD34, and CD31 expression in the endothelial cells of the capillaries, characteristic of massive FMH placenta. This article also reviews the particular histopathological changes in FHM placenta according to the placental lesion classification system.
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Affiliation(s)
- Yushuang Zheng
- Departments of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Donglu Li
- Departments of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinran Li
- Departments of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Aman Zheng
- Departments of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, China
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fan Wang
- Departments of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, China.
- The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Mir IN, White SP, Steven Brown L, Heyne R, Rosenfeld CR, Chalak LF. Autism spectrum disorders in extremely preterm infants and placental pathology findings: a matched case-control study. Pediatr Res 2021; 89:1825-1831. [PMID: 32950030 DOI: 10.1038/s41390-020-01160-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of autism spectrum disorders (ASD) is 5-fold higher in preterm (PT) infants born ≤28 weeks gestational age (GA) as compared to the general population. The relationship between placental pathologic lesions and ASD in PT infants has not been studied. OBJECTIVES The objective of this study was to determine the association of placental pathology with the occurrence of ASD in PT infants born ≤28 weeks GA. STUDY DESIGN A matched case-control study to identify confirmed ASD cases (n = 16) and matched controls (n = 48) born at Parkland Hospital between January 2012 and December 2015. Patients were matched using known variables associated with increased risk of ASD in PT infants. Placental histology from all births was reviewed. RESULTS Children with ASD had 2-fold greater incidence of multiple placental pathologic lesions vs. matched controls [11/16 (69%) vs.16/48 (33%), respectively; P = 0.01]. In contrast, single placental pathologic lesions were not associated with ASD [5/16 (31%) vs. 21/48 (43%), respectively; P = 0.1]. CONCLUSIONS In this study, we have demonstrated an association between the increasing complexity of histologic placental lesions and the later risk for ASD in infants born ≤28 weeks GA. Thus, placental pathology findings may be valuable in further understanding the prenatal pathologic processes underlying ASD in PT infants. IMPACT PT infants with ASD have a 2-fold greater incidence of multiple placental pathologies. This is the first study to report an association between the complexity of histologic placental lesions and later risk of ASD in infant born extremely PT (i.e., ≤28 weeks GA). This study reiterates the importance of examining placental pathologic lesions, since placental evidence of antenatal insults correlates with postnatal morbidities and mortality in PT infants.
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Affiliation(s)
- Imran N Mir
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA.
| | - Stormi P White
- Department of Pediatrics, Division of Autism and Related Disorders, Emory University School of Medicine and Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
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Massive feto-maternal hemorrhage: Two cases. J Gynecol Obstet Hum Reprod 2019; 48:533-535. [PMID: 30898631 DOI: 10.1016/j.jogoh.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/18/2019] [Accepted: 03/15/2019] [Indexed: 11/20/2022]
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5
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Lewis NE, Marszalek L, Ernst LM. Placental Pathologic Features in Fetomaternal Hemorrhage Detected By Flow Cytometry. Pediatr Dev Pathol 2017; 20:142-151. [PMID: 28326960 DOI: 10.1177/1093526616687652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Fetomaternal hemorrhage (FMH) is a poorly understood entity that can have significant clinical effects. Flow cytometry is a reliable and relatively new method for FMH diagnosis. The objective of this study was to correlate placental pathology with FMH detected by flow cytometry. Methods All patients with available placentas and FMH flow cytometric testing performed from 2009 to 2015 were retrospectively reviewed. Cases were defined as ≥0.10% fetal red blood cells (RBCs) in the maternal circulation while controls contained <0.10%. Placental findings associated with FMH were determined. Results In this study, 35 cases and 79 controls were identified. Villous dysmaturity/immaturity was significantly more prevalent among the cases compared to the controls. Placentas with villous edema and nucleated RBCs (nRBCs) in fetal vessels were associated with greater mean volumes of fetal blood in the maternal circulation. Fetal and maternal vascular pathology was more frequent in the controls. When the cases were stratified into mild (<30 mL), moderate (30 mL-100 mL), and severe (>100 mL) FMH, nRBCs, villous dysmaturity/immaturity, and villous edema were all positively correlated with increasing FMH severity. The cases were more likely than the controls to display ≥2 of these 3 features. Fetal nRBCs within fetal vessels were semi-quantified and moderate to severe numbers of nRBCs were associated with higher mean volumes of fetal blood in maternal circulation. Conclusions Villous dysmaturity/immaturity, villous edema, and nRBCs in fetal vessels, findings compatible with fetal anemia, in addition to relatively few chronic placental changes, are the most significant placental findings in FMH detected by flow cytometry.
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Affiliation(s)
- Natasha E Lewis
- 1 Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, Illinois, USA
| | - Laura Marszalek
- 1 Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, Illinois, USA
| | - Linda M Ernst
- 1 Northwestern University Feinberg School of Medicine, Department of Pathology, Chicago, Illinois, USA
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Solomonia N, Playforth K, Reynolds EW. Fetal-maternal hemorrhage: a case and literature review. AJP Rep 2012; 2:7-14. [PMID: 23946896 PMCID: PMC3653511 DOI: 10.1055/s-0031-1296028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/26/2011] [Indexed: 11/29/2022] Open
Abstract
Nearly all pregnancies include an insignificant hemorrhage of fetal blood into the maternal circulation. In some cases, the hemorrhage is large enough to compromise the fetus, resulting in fetal demise, stillbirth, or delivery of a severely anemic infant. Unfortunately, the symptoms of a significant fetal-maternal hemorrhage can be subtle, nonspecific, and difficult to identify at the time of the event. We present the case of a severely anemic newborn who was delivered in our facility with an extensive literature review.
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Bromham DR, Fay R. Fetal heart rate patterns associated with massive feto-maternal haemorrhage. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618309071224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schmidt WA, Affleck JA, Jacobson SL. Fatal fetal hemorrhage and placental pathology. Report of three cases and a new setting. Placenta 2005; 26:419-31. [PMID: 15850647 DOI: 10.1016/j.placenta.2004.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2004] [Indexed: 11/26/2022]
Abstract
We report three cases of late third trimester fetal death in utero consequent to fetal exsanguination from the chorionic vasculature. In general, fetal hemorrhage is unusual, exsanguination is rare and the location and basis of the hemorrhage varies widely. Intragestational and intrapartum hemorrhage is far more often of maternal rather than fetal origin. Even when severe, the former is almost always manageable whilst the latter may be clinically obscure, intractable, catastrophic and fatal. In this presentation, we review and characterize fetal hemorrhage by anatomical location and on the basis of its underlying origins. In our first two cases, the chorionic vascular failure is understood on the basis of mechanical factors, such as tearing by the presenting part or an amniotomy hook. Our third case demonstrates the first reported instance in which a severe chorionic vasculopathy has damaged a placental surface vessel sufficiently to permit spontaneous rupture and fetal exsanguination.
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Affiliation(s)
- W A Schmidt
- Department of Pathology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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Dziegiel MH, Koldkjaer O, Berkowicz A. Massive antenatal fetomaternal hemorrhage: evidence for long-term survival of fetal red blood cells. Transfusion 2005; 45:539-44. [PMID: 15819674 DOI: 10.1111/j.0041-1132.2005.04262.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation of the life span of fetal red blood cells (RBCs) in the maternal circulation. CASE REPORT The mother went to the obstetrician twice antepartum owing to symptoms assumed to be preeclampsia; that, however, was not found. She later delivered by cesarean section owing to diminished fetal movements. No fetal weight gain was observed during the last 2 weeks of pregnancy. STUDY DESIGN AND METHODS Fetal RBCs were quantified by flow cytometry with anti-HbF, anti-Fy(a), anti-s, and anti-Jk(b) on a regular basis. RESULTS The infant had anemia at delivery and an FMH was determined to be 314 +/- 17 mL (+/- SD) of whole blood. It is assumed that the two antenatal visits were associated with the FMH. Postpartum follow-up showed that fetal RBCs in the maternal circulation were detectable with anti-HbF up to 119 days. Quantification by flow cytometry based on anti-HbF was in agreement with quantification based on anti-Fy(a), anti-s, and anti-Jk(b), although they were less sensitive. CONCLUSION ABO-compatible fetal RBCs from an FMH had a life span in the maternal circulation close to that of adult RBCs.
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Affiliation(s)
- Morten H Dziegiel
- H:S Blood Bank KI2034, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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David M, Smidt J, Chen FCK, Stein U, Dudenhausen JW. Risk factors for fetal-to-maternal transfusion in Rh D-negative women--results of a prospective study on 942 pregnant women. J Perinat Med 2004; 32:254-7. [PMID: 15188800 DOI: 10.1515/jpm.2004.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the incidence of severe fetal-to-maternal transfusion after delivery and to identify risk factors. MATERIAL AND METHODS In a prospective study at the Department of Obstetrics, Charité, Campus Virchow-Klinikum, Berlin, Germany, we analyzed the incidence of severe fetal-to-maternal transfusion (>10 ml) and fetal-to-maternal hemorrhage (>25 ml) in Rh D-negative pregnant women after delivery of Rh D-positive infants. 942 women were included in the study and Kleihauer-Betke tests were performed. The results were compared to perinatal data. RESULTS Fetal-to-maternal hemorrhage occurred in 13 cases out of 942 (incidence of 1.3%) and severe fetal-to-maternal transfusion in 61 cases (6.5%). In all of the cases with fetal-to-maternal hemorrhage, mothers were compatible with their infants in ABO-system. The incidence of fetal-to-maternal transfusion and its severe form was significantly higher in twin pregnancies (7/21 cases and 5/21 cases respectively, 33.3% and 23.8%) than in singleton pregnancies (22.5%, and 5.9%, P<0.001). All other factors, such as maternal age, parity, ethnicity, mode of delivery, presentation, duration of first and second stage of labor, CTG, or Apgar score were not associated with an increased risk of severe fetal-to-maternal transfusion. CONCLUSIONS Twin pregnancy is the only independent risk factor for severe fetal-to-maternal transfusion. ABO-incompatibility between mother and infant seems to be protective against Rh D-alloimmunization.
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Affiliation(s)
- Matthias David
- Universitätsklinikum Charité, Klinik für Frauenheilkunde und Geburtshilfe, Campus Virchow-Klinikum, Berlin, Germany.
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Valdès V, Goldrey M, Hamon I, Hascoet JM. [Massive fetomaternal transfusion after induction of labor by oxytocin]. Arch Pediatr 2002; 9:818-21. [PMID: 12205793 DOI: 10.1016/s0929-693x(01)00995-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED Severe fetomaternal transfusions are seldom, but may lead to neonatal morbidity or death. CASE REPORT We report a case of lethal fetomaternal transfusion in which a failure to induce labour, at term, can be suspected. COMMENTS We emphasize the need of a close monitoring of the fetal well-being in cases of failed induced labour at term.
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Affiliation(s)
- V Valdès
- Service de néonatologie-soins intensifs et réanimation néonatals, maternité régionale A. Pinard, 10, rue du Docteur-Heydenreich, BP 4213, 54042 Nancy, France
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Affiliation(s)
- J Kew
- Department of Obstetrics and Gynaecology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, United Kingdom
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Abstract
The etiology, clinical presentation, obstetrical antecedents, and outcome of pregnancies complicated by large fetomaternal hemorrhage (FMH) were reviewed by doing a MEDLINE search from 1966 to the present and manual search before 1966. One hundred thirty-four infants with FMH > 50 dl were reported in the literature. The primary variables: birth weight, gestational age, presence of sinusoidal fetal heart rate pattern, decrease or absent fetal body movements (FBM) estimated the amount of fetomaternal bleeding and the pretransfusion hemoglobin. Other variables included the condition of the infants at birth, erythroblasts, and reticulocyte blood counts at birth, as well as the year of publication. Thirty-five of the 134 cases were preterm. Twenty infants born to mothers reporting decreased or absent FBM survived. FBM was absent in 17 cases for a period ranging between 24 hours and 7 days. In this group, six infants survived, five were stillborn, and five died in the neonatal period. A sinusoidal heart rate (SHR) pattern was reported in 21 cases. A SHR pattern was associated with decreased FBM in 13 cases (39.3 percent). Fifteen cases with sinusoidal fetal heart rate pattern survived (71.4 percent). Both decreased or absent FBM and SHR patterns were reported more often in 1990 or later than before 1990 (P < .0017 and P < .008, respectively). The cause of FMH was not known in 82 percent of the cases. The most common presenting symptoms of FMH were anemia at birth (35.2 percent), decreased or absent FBM (26.8 percent), and unexpected stillbirths (12.5 percent). Seventeen intrauterine transfusions were performed in nine cases (eight survived). A negative correlation was found between pretransfusion hemoglobin and FMH (r = -0.35; P = .0019). No significant difference was found between the cases with FMH of > 200 ml or < 200 ml. Thus, decreased or absent FBM, SHR pattern, or hydrops fetalis are late signs of FMH. Other means of early detection are needed. The role of intrauterine transfusion (IUT) needs to be better defined. The inadequate outcome data indicate the need to follow infants born with large FMH into childhood to document the effect on the central nervous system.
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Affiliation(s)
- G P Giacoia
- Department of Pediatrics, University of Oklahoma College of Medicine, Tulsa, USA
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Nash TG, Fathy H, Sellappan S, Nasar M. Massive feto-maternal haemorrhage. J OBSTET GYNAECOL 1995. [DOI: 10.3109/01443619509020695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
We report a term infant who presented with focal seizures and was diagnosed with a large left hemispheral infarct. Evaluation revealed extensive fetomaternal hemorrhage and subsequent neuroimaging disclosed a classic border zone infarct consistent with a hypoperfusion injury. We postulate that fetomaternal hemorrhage should be considered in the differential causation of neonatal stroke. The unilaterality of the lesion in this patient is difficult to explain.
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Affiliation(s)
- L H Boyce
- Department of Neurology, College of Physicians and Surgeons of Columbia University, New York, New York
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Heise RH, Van Winter JT, Ogburn PL. Identification of acute transplacental hemorrhage in a low-risk patient as a result of daily counting of fetal movements. Mayo Clin Proc 1993; 68:892-4. [PMID: 8371606 DOI: 10.1016/s0025-6196(12)60698-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In this report, we describe a case of acute, massive fetomaternal hemorrhage that was detected during the 32nd week of pregnancy by maternal perception of decreased fetal movement and suggestion of a sinusoidal heart rate pattern. Additional evaluation revealed an abnormal biophysical profile (2 of 10) and intermittent late decelerations. Because of the substantially decreased fetal reserve, cesarean section was emergently performed. A 1,880-g female infant was delivered. She had an initial hemoglobin concentration of 1.9 g/dl and a hematocrit of 5.7% but did well after appropriate transfusion therapy. This case confirms the importance of daily counting of fetal movements in low-risk patients. In addition, it emphasizes that early diagnosis and treatment of massive fetomaternal hemorrhage can improve infant survival.
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Affiliation(s)
- R H Heise
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905
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Abstract
The complete clinical evaluation of pregnancy loss, stillborn infants, and neonatal deaths can result in the anticipation of an accurate diagnosis in a high percentage of cases. Appropriate focused fetal studies may include a clinical examination, fetal karyotype, photographs, skeletal radiographs, fetal autopsy, examination of the placenta and cord, and occasionally cultures or DNA studies. Knowledge of specific causes of fetal death and their clinical presentation can greatly assist the pediatrician in choosing the most appropriate studies. Many of the disorders leading to fetal death carry significant genetic recurrence risks, making an accurate diagnosis even more crucial. As our understanding of the causes of pregnancy loss improves, so does our ability to provide families with accurate counseling regarding their reproductive options.
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Affiliation(s)
- C J Curry
- Department of Medical Genetics/Prenatal Detection, Valley Children's Hospital, Fresno, CA
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Ishihara H, Takahashi H, Takeuchi Y, Kigawa J, Sawazumi K, Ito T, Maeda K. Massive fetomaternal hemorrhage: case report. ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1990; 16:225-8. [PMID: 1708232 DOI: 10.1111/j.1447-0756.1990.tb00230.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Massive fetomaternal hemorrhage (FMH) is rare. Early diagnosis is important because FMH has a poor prognosis in the antepartum or early postpartum period. A case of massive FMH in which 400 ml blood was lost is presented here. Fetal anemia was suspected from the sinusoidal fetal heart rate pattern. The hemorrhage in the maternal circulation was diagnosed before delivery by using the Kleihauer-Betke test. An emergency cesarean section was performed. The cord hemoglobin level was 3.7 g/dl. The baby's severe anemia was treated with a neonatal blood transfusion. In this case, the baby had a good clinical course. Early diagnosis and treatment of massive FMH are necessary for a good prognosis.
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Affiliation(s)
- H Ishihara
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
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21
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Goodwin TM, Breen MT. Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma. Am J Obstet Gynecol 1990; 162:665-71. [PMID: 2316567 DOI: 10.1016/0002-9378(90)90979-h] [Citation(s) in RCA: 153] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two hundred five consecutive cases of noncatastrophic trauma occurring during the second half of pregnancy were evaluated prospectively. Pregnancy complications as a result of trauma occurred in 18 of 205 patients (8.8%): premature labor (n = 10), placental separation (n = 5), fetal injury (n = 1), and fetal death (n = 2). Multiple regression analysis of the data base showed obstetric findings (contractions, uterine tenderness, and bleeding) on presentation to be highly associated with complications (17/88; 19.3%). In their absence complications were rare (1/117; 0.9%). Detectable fetomaternal hemorrhage was significantly more common in trauma patients (18/205) than in control subjects (2/110) (p less than 0.01), but its role in managing trauma patients was limited to detection of rare massive hemorrhage (1/205) and detection of rare hemorrhage exceeding that covered by the standard Rho (D) immune globulin dose (2/205). Fetomaternal hemorrhage need not be quantitated in patients who lack obstetric findings on presentation. Despite rare reports of delayed abruptio placentae, it is doubtful that prolonged observation (greater than 2 to 3 hours) in the hospital is necessary in patients who lack obstetric findings on initial presentation.
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Affiliation(s)
- T M Goodwin
- Department of Obstetrics and Gynecology, Maricopa Medical Center, Phoenix, Arizona
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22
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Rosenn B, Ben Chetrit A, Palti Z, Hurwitz A. Sinusoidal fetal heart rate pattern due to massive feto-maternal transfusion. Int J Gynaecol Obstet 1990; 31:271-3. [PMID: 1969369 DOI: 10.1016/0020-7292(90)91022-i] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 30-year-old woman presented with mild abdominal discomfort and decreased fetal movements in the 34th week of her third pregnancy. Fetal monitoring revealed a sinusoidal heart rate pattern, and abdominal delivery was promptly performed, with the newborn having a hematocrit of 7% due to massive fetomaternal transfusion. Fetal resuscitation was followed by a favorable outcome. The sinusoidal heart rate is discussed, with emphasis on the need for proper and prompt recognition of its significance.
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Affiliation(s)
- B Rosenn
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel
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23
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Li TC, Bromham DR. Fetomaternal macrotransfusion in the Yorkshire region. 2. Perinatal outcome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1988; 95:1152-8. [PMID: 3207644 DOI: 10.1111/j.1471-0528.1988.tb06793.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The perinatal outcome associated with fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage greater than or equal to 10 ml, was investigated in a study group of 179 cases of FMMT and compared with the outcome in 322 controls selected from the same population. Perinatal mortality and morbidity occurred more frequently in the case group (P less than 0.01). The mean Apgar score at 1 min and the cord haemoglobin level differed significantly between the case and control groups (P less than 0.01) and showed a significant inverse correlation with the estimated volumes of FMMT (P less than 0.0001). There was no significant difference in birthweight between the case and control groups. The mean estimated volumes of FMMT associated with perinatal mortality and with low cord haemoglobin (less than or equal to 9.0 g/dl) were significantly higher than the mean volume in the case group as a whole, which suggests the possibility of adapting these observations to a screening procedure.
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Affiliation(s)
- T C Li
- Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds
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Li TC, Bromham DR, Balmer BM. Fetomaternal macrotransfusion in the Yorkshire region. 1. Prevalence and obstetric factors. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1988; 95:1144-51. [PMID: 3264722 DOI: 10.1111/j.1471-0528.1988.tb06792.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The prevalence of fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage (FMH) greater than or equal to 10 ml, was calculated in a series of 15,724 postpartum Kleihauer tests recorded in six hospitals. The mean prevalence in this retrospective survey, the largest published to date, was 0.83% (SEM 0.22) but values varied according to the technique used to quantify the volume of FMH. A number of obstetric factors that have been suggested as influencing the occurrence and extent of FMMT were examined. The frequencies of these factors in cases with FMMT were compared with those in a control group without FMMT selected from the same population. Manual removal of the placenta (P less than 0.0001) and fetal distress in labour (P less than 0.0001) occurred significantly more frequently in the case group. We are unable to confirm previous reports that other obstetric factors may influence the occurrence and extent of FMMT.
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Affiliation(s)
- T C Li
- Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds
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Abstract
In the past 40 years, tremendous advances in the treatment of hemolytic disease have been made. The perinatal mortality has been reduced considerably. Rh immunoprophylaxis has decreased the incidence of Rh immunization to around 6 per 100,000 live births. Nevertheless, treatment of severe hemolytic disease is still essential. Increased reliability of diagnostic procedures have made early detection and optimal treatment of hemolytic disease possible. Treatment by plasmapheresis is still controversial. Although believed to be beneficial by some authors, conclusive evidence of its efficacy has not been obtained. With preterm induction of birth at 32 weeks of gestation, the chances for survival are 95%. Improvement of techniques and the use of modern real-time ultrasound equipment have made intrauterine intraperitoneal transfusion, in experienced hands, a relatively safe and successful procedure. Intravascular transfusion appears beneficial in early pregnancy. Combination of both techniques will probably be the answer for the future. The development of neonatal intensive care facilities has made a major contribution to the survival of children with haemolytic disease. The relative low incidence of haemolytic disease has made it imperative that treatment should take place in centers where experience and special skill are available.
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Herman A, Bukovsky Y, Benson L, Weinraub Z, Caspi E. Intrapartum use of fetal scalp hematocrit in the diagnosis of profound fetal anemia caused by fetomaternal hemorrhage. Am J Obstet Gynecol 1987; 157:1182-3. [PMID: 3688072 DOI: 10.1016/s0002-9378(87)80290-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A case of massive fetomaternal hemorrhage that caused profound fetal anemia is presented. Timely intrapartum assessment of fetal hematocrit of 15% by means of scalp sampling aided in the delivery of a newborn infant with hemoglobin of 3 gm/dl and hematocrit of 10%.
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Affiliation(s)
- A Herman
- Department of Obstetrics and Gynecology, Assaf Haroffe Medical Center, Zerifin, Israel
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Baldwin SA, Webb JB. Antepartum feto-maternal haemorrhage. J OBSTET GYNAECOL 1987. [DOI: 10.3109/01443618709013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - J. B. Webb
- Northwick Park Hospital, Harrow, Middlesex
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Fliegner JR, Fortune DW, Barrie JU. Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity. Aust N Z J Obstet Gynaecol 1987; 27:158-61. [PMID: 2445333 DOI: 10.1111/j.1479-828x.1987.tb00971.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Spontaneous fetomaternal haemorrhage is an important, but usually overlooked, cause of perinatal mortality and morbidity. Although fetomaternal bleeding in the third trimester of pregnancy is common it is normally less than 0.1 ml. A fetal macrotransfusion (greater than 5 ml) is uncommon, but is important because it is insidious, unexpected and usually occurs in completely normal pregnancies. This paper analyses the perinatal mortality and morbidity associated with occult fetomaternal haemorrhage at the Royal Women's Hospital, Melbourne. It may lead to fetal distress before and during labour, unexplained stillbirth, or nonhaemolytic neonatal anaemia. A Kleihauer test on maternal blood will readily detect fetomaternal bleeding, and we describe a simple way of calculating the absolute volume of fetal red cells present. Greater awareness of the problem may eventually lead to diagnosis sufficiently early to permit effective treatment.
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Affiliation(s)
- J R Fliegner
- Department of Obstetrics & Gynaecology, Royal Women's Hospital, Melbourne
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Santamaria M, Benirschke K, Carpenter PM, Baldwin VJ, Pritchard JA. Transplacental hemorrhage associated with placental neoplasms. PEDIATRIC PATHOLOGY 1987; 7:601-15. [PMID: 3449817 DOI: 10.3109/15513818709161424] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a case of choriocarcinoma in situ arising from a term placenta in an otherwise normal pregnancy that resulted in fetal hydrops and intrauterine fetal death from chronic fetal-maternal hemorrhage (FMH). The clinical and pathologic features are described and compared with the few similar cases reported and with an additional placental choriocarcinoma found in our files. We also describe the clinical and pathologic observations of two chorangiomas that caused massive FMH and led to fetal death.
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Affiliation(s)
- M Santamaria
- Department of Pathology, University of California, San Diego Medical Center 92103
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Abstract
Fetomaternal hemorrhage can result from different types of trauma and may be followed by fetal anemia, fetal death, or isoimmunization. We prospectively studied the frequency and volume of fetomaternal hemorrhage, fetal well-being, abruptio placentae, and fetal outcome in 32 pregnant patients suffering recent trauma. Fetomaternal hemorrhage occurred in nine of 32 trauma patients (28%) with a mean volume of 16 ml +/- 14.3(SD). There was a statistically significant difference in the frequency and mean volume of fetomaternal hemorrhage in this group over that in gestational-age-matched controls. Neither the nature of the trauma nor the gestational age was related to the frequency or volume of fetomaternal hemorrhage. The outcome in three of the nine trauma patients who sustained fetomaternal hemorrhage was poor; fetal anemia, paroxysmal atrial tachycardia, and fetal death occurred in each one. Maternal trauma remains a significant cause of maternal and fetal morbidity and death, and the use of the Kleihauer-Betke analysis is indicated to identify fetomaternal hemorrhage. Rh-immune globulin therapy should be given to Rh-negative patients with fetomaternal hemorrhage.
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Fay RA. Feto-maternal haemorrhage as a cause of fetal morbidity and mortality. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1983; 90:443-6. [PMID: 6849846 DOI: 10.1111/j.1471-0528.1983.tb08941.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Massive feto-maternal haemorrhage is a cause of significant fetal morbidity and mortality, but is often overlooked because screening for fetal erythrocytes in the maternal circulation has not been a routine procedure in stillbirths, fetal distress or neonatal anaemia; there are few recognized clinical symptoms or signs, or histopathological features. This report covers three cases. A screening blood test in the last month of pregnancy could be of value in detecting feto-maternal haemorrhage before irreversible damage to the fetus occurs.
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Chamberlain EM, Scott JR, Wu JT, Rote NS, Egger MJ. A comparison of acid-elution techniques and alpha-fetoprotein levels for the detection of fetomaternal bleeding. Am J Obstet Gynecol 1982; 143:912-7. [PMID: 6179421 DOI: 10.1016/0002-9378(82)90473-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Practical and reliable methods to identify and/or quantitate fetal blood are becoming more important in the modern practice of obstetrics. In this study, two commercially available acid-elution techniques were compared with plasma -alpha-fetoprotein (AFP) by simultaneously testing samples of fetal blood mixed with adult blood in fixed ratios. Thirty-one samples representing a range of amounts of fetomaternal hemorrhage, from 0.024 to 48 ml, were analyzed. The acid-elution techniques were equally effective in detecting fetomaternal hemorrhage greater than 15 ml, but the bmc Reagent set was the most accurate for detection of small numbers of fetal erythrocytes. The accuracy of AFP was greater than that of either acid-elution technique, but its clinical usefulness is limited by the necessity for a prehemorrhage sample.
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Verco CJ, Jones WR. Monoamniotic twin pregnancy complicated by massive fetal-maternal haemorrhage. Aust N Z J Obstet Gynaecol 1981; 21:186-7. [PMID: 6949573 DOI: 10.1111/j.1479-828x.1981.tb00917.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bergin FT, Cefalo RC, Lewis PE. Self-limited hemolytic transfusion reaction in an ABO-incompatible maternal-fetal unit. Am J Obstet Gynecol 1978; 132:115-6. [PMID: 696776 DOI: 10.1016/0002-9378(78)90812-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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