Occult Fetomaternal Haemorrhage As a Cause of Fetal Mortality and Morbidity

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.

Successful in utero Treatment of Chronic and Massive Fetomaternal Hemorrhage with Fetal Hydrops

“…The minimal amount of fetal blood transfused to the mother leading to a poor outcome is unknown [15] . A review of fetal death after FMH found a wide interval between 23 and 51% of the fetal blood volume [19] . The neurological prognosis after massive FMH was not evaluated and the consequence of the ane- mia on the fetal brain are unknown.…”

Fetal-Maternal Hemorrhage: A Case and Literature Review

“…Most are diagnosed retrospectively after an infant is stillborn, experiences unexplained fetal distress or is born with symptoms consistent with a hemorrhage. 34 Prenatally, the mother may present with a history of decreased or absent fetal movement. 13 A 1997 study found in 27% of cases, decreased or absent fetal movement was the presenting symptom of a fetal hemorrhage.…”

Computerised measurement of fetal heart rate variation in a case of fetomaternal haemorrhage

“…The proportion of pregnancies in which fetomaternal transfusion causes fetal death is about 0.04% (Laube & Schauberger 1982). The presenting symptom is often a decrease in fetal movements (Fliegner et al 1987). Avoidance of intrauterine death in a viable, nonmalformed fetus is clearly a vital part of antenatal care.…”