Massive Feto-maternal Hemorrhage: A Case Report

Abstract

Massive feto-maternal hemorrhage (FMH) is rare. Late signs and symptoms are decreased fetal movement (in 35 % of cases), unexpected stillbirth (in 12.5 % of cases), sinusoidal heart rate (in 1 % of cases) or fetal anomalies. Early diagnosis is important to improve the prognosis of the newborn ante partum and in the early postpartum period. We report a case of a female newborn with unexpected, severe anemia. The hemorrhage into the maternal circulation was diagnosed after delivery using the Kleihauer-Betke test (BK). In this case, late fetal signs of anemia, such as reduction of fetal movement and a sinusoidal pattern in fetal heart tracing (CTG) or fetal hydrops, were not observed during pregnancy. Moreover, there was no evidence of trauma during pregnancy. Fortunately, the patient was referred to hospital during the late gestation period because of spontaneous membrane rupture. Fetal CTG was immediately noted to be pathological, and an emergency cesarean section was performed. Massive feto-maternal hemorrhage is an important cause of mortality in fetuses without other apparent causes of death. For this reason BK testing is recommended in all cases of fetal death, including those with fetal anomalies.