Subsequent pregnancy in women with a history of peripartum cardiomyopathy is associated with a significant decrease in left ventricular function and can result in clinical deterioration and even death.

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OBJECTIVE:To report the incidence of massive fetomaternal hemorrhage (FMH) associated with fetal death and to test the hypothesis that FMH is more likely to occur in those with risk factors for FMH. STUDY DESIGN:All cases of fetal death of infants weighing Ͼ500 gm between January 1, 1990 and December 31, 1994 were reviewed for evidence of massive FMH (Ն2% fetal cells in the maternal circulation as measured by the BetkeKleihauer test). Women with risk factors were compared with those without risk factors with respect to the occurrence of massive FMH. RESULTS:The prevalence of massive FMH was 14 of 319 (4.4%) cases, occurring in 4 of 102 (3.9%) of those with risk factors and 10 of 217 (4.6%) of patients without risk factors (p ϭ 0.78). Otherwise unexplained fetal death was associated with massive FMH in 5 of 141 (3.5%). Major fetal anomalies were present in 5 of 14 (35.7%) cases of massive FMH. CONCLUSION:Clinical risk factors do not predict an increased likelihood of massive FMH. Massive FMH is associated with fetal anomalies. Betke-Kleihauer testing should be performed in all cases of fetal death, including those with anomalies regardless of the presence or absence of risk factors for FMH.Fetal death has been associated with massive fetomaternal hemorrhage (FMH) in both case reports and in several small series. [1][2][3][4][5] Fewer than 100 cases have been reported in which a specific assay for FMH, the Betke-Kleihauer (BK) test, was performed to determine the cause of fetal death. Due to the small number of cases reported, the prevalence of massive FMH when fetal death occurs is uncertain. It has not been possible to determine whether or not conditions that increase the risk for FMH actually increase the likelihood that FMH is present as a cause for fetal demise.The purpose of this study is to report the incidence of massive FMH in a large cohort of fetal deaths. The secondary purpose is to test the hypothesis that massive FMH is more likely to occur among patients with traditionally known risk factors for FMH than those without these risk factors. MATERIALS AND METHODSAll cases of fetal death during the period between January 1, 1990 and December 31, 1994 evaluated at the Los Angeles County/University of Southern California Medical Center were reviewed. During this time period the BK test was ordered as part of the evaluation for fetal death at the discretion of the attending physician. The maternal and fetal charts for each stillbirth were reviewed at the end of each month. A clinical summary of each case was recorded. The results of the tests performed for the evaluation of fetal death, including autopsy and the pathologic examination of the placenta, if performed, were reviewed by a research nurse and recorded in a database.We divided the fetal deaths in which the BK test was performed

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