570 Severe fetomaternal hemorrhage. a report of eight cases

Abstract

BackgroundFetomaternal hemorrhage (FMH) is a poorly understood condition in which involves fetal blood loss into the maternal circulation of more than 150ml or more than half fetal blood volume. Massive fetomaternal hemorrhage (>150 ml) occurs in 0.12 to 0.5% of pregnancies. Very small amount of fetal red cells are normally detectable in all pregnancies. Massive fetomaternal bleed is very rare and even rarer is the resultant severe anemia causing early neonatal death, up to 0 0,04% of all births, despite an uneventful normal pregnancy until the end. Some predisposing factors such as abdominal injury, placenta abruption and chorionic villus sampling have been described. The presentation is frequently without an evident precipitating factor. Recognition may become apparent only after injury has occurred, if at all. Case Report: We report 8 cases of severe fetomaternal transfusion in our institute at the time 2011-2021. 3 of them were preterm infants and 5 of them were mature infants. The type of admission at 5 of them was Caesarean section und 3 of them were born normally. The mean Hb concentration was 4,6 g/dl. The reasons for the Caesarean section as a delivery method were placenta abruption in one case, pathological CTG in 2 cases and abnormal position of the fetus during birth in the other 2 cases. Complications and/or diseases reported during pregnancy were gestational diabetes (at 1 pregnant), thyroid dysfunction (2 pregnants) und thalassemia minor (1 pregnant). 7 of the 8 neonates underwent a neonatal resuscitation. Neonatal resuscitation included positive pressure ventilation, oxygen, and intubation. This neonates responded well to blood transfusions, a pressor, and respiratory support. One of them was cardiovasculary and respiratory stable and needed neither a neonatal resuscitation nor a 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. All of them were discharged home at a good clinical condition. All of them had normal brain sonographic findings at the time of home discharge. Conclusion: FMH may be a significant cause of neonatal anemia. Diagnosis of FMH is highly dependent on physician awareness of the condition.Management remains challenging.Although the occurrence of large antenatal fetomaternal hemorrhage is fortunately rare, this entity likely remains underreported and underrecognized. A long term follow up of these children is necessary.