Large Fetomaternal Hemorrhage Clinical Presentation and Outcome

Abstract

Fetomaternal hemorrhage, the passage of fetal red blood cells into the maternal circulation, occurs in up to 75% of pregnancies, but its volume is nearly always less than 1 mL. This retrospective analysis, covering the years 1987-2000, included 16 infants who were treated during this time for fetomaternal hemorrhage of 20 mL or more. These infants were among more than 65,000 born during the period under review. Seven infants (44%) were born before 37 weeks gestation. Five of the 16 affected infants (31%) had adverse outcomes; 3 died and 2 had periventricular leukomalacia. Nine infants received packed red cell transfusions and 4 underwent double-volume exchange transfusions. Both procedures were used in 2 cases and 1 infant died before treatment could be instituted. Only 2 of the 16 infants did not require transfusion. Five infants were delivered vaginally or by planned cesarean section. In 6 other infants, fetal movements were reduced or absent, prompting emergency cesarean section. Fetal decelerations were noted in 2 cases. Infants for whom there was antenatal concern did as well as the others, and these groups had similar amounts of fetomaternal hemorrhage. Seven infants had hydrops fetalis, respiratory distress, or bradycardia when born, and 5 of them had an adverse outcome. Pallor by itself did not predict a negative outcome. Again, the amount of fetomaternal hemorrhage did not correlate with the outcome. The only factors significantly associated with adverse outcomes were the postnatal presentation and an initial hemoglobin below 4 g/dL. Adverse outcomes are not uncommon in newborn infants with fetomaternal hemorrhage of 20 mL or more. The initial hemoglobin level was a better predictor than the volume of bleeding in this series.