Massive Fetomaternal Hemorrhage Remote from Term: Favorable Outcome after Fetal Resuscitation and Conservative Management

Abstract

Fetomaternal hemorrhage (FMH) is a rare condition that requires early diagnosis and appropriate treatment due to its potentially severe consequences. We report a case of massive FMH presenting as decreased fetal movement, fetal hydrops, and intracranial hemorrhage at 24 weeks. Treatment considerations were made and amniocentesis, fetal blood sampling, and fetal blood transfusion via cordocentesis were performed. Recurrent FMH required subsequent fetal transfusion 2 days later. Surveillance was continued twice weekly until the patient delivered a viable infant at 38 weeks after spontaneous labor. Recurrent FMH was unpredictable due to its unclear etiology and absence of precipitating events, however close surveillance proved effective.

Massive feto-maternal transfusion: A literature review and case report

“…The management of FMH varies according to gestational age, estimated amount and duration of hemorrhage and fetus' stability. In the early third trimester of gestation, but also in a very premature fetus (<28 weeks gestation) who has evidence of a chronic massive FMH (severe anemia, normal results of blood gas indices, sinusoidal CTG pattern and hydrops) serial Intrauterine Transfusions (IUT) could be performed [43]. Instead, in a low grade FMH a wait-and-see management was possible, following the fetal well-being through CTG monitoring to evaluate fetal heart variability, serial KB test to determine how FMH is evolving and ultrasound examinations to evaluate hydrops, fetal growth and MCA-PSV [44].…”

Prenatal diagnosis of fetomaternal hemorrhage by a novel hydrogel fluoroimmunoassay that accurately quantifies fetal haemoglobin

“…Additionally, anti-Kell, anti-E, and anti-C IgG antibodies may also induce allogeneic immunity via the placenta ( Erhabor et al, 2020 ). Alloimmunization following FMH can cause anemia, edema, jaundice, and even death in fetuses and newborns ( Christino Luiz et al, 2019 ; Fan et al, 2021 ). Statistics indicate that fetal mortality due to FMH can reach 10% ( Bowman, 2010 ).…”

A novel enzyme-linked immunostaining technique based on silk membrane for the prenatal detection of fetomaternal haemorrhage

“…The essence of detecting FMH is the quantitative detection of fetal red blood cells in the peripheral blood of pregnant women ( Troia et al, 2019 ). Prenatal detection of maternal hemorrhage is the foundation for preventing newborn hemolytic disease and administering immunoglobulin therapy ( Christino Luiz et al, 2019 ; Cormack et al, 2019 ; Flynn et al, 2022 ).…”