Idiopathic chronic fetomaternal haemorrhage resulting in hydrops--a case report

We report a case of idiopathic chronic fetomaternal haemorrhage (FMH) that developed in the late trimester.

The patient presented with decreased fetal movement at 38 weeks gestation. Antenatal follow-up was uneventful with normal serial ultrasound performed at 22 and 35 weeks. Prior to delivery, the cardiotocography (CTG) was abnormal with decreased baseline variability and late deceleration. Emergency lower segment caesarean section was performed. Upon delivery, a hydropic neonate with a haemoglobin level of 3.9 g/dL was noted. The Kleihauer-Betke test was positive, confirming FMH.

The neonate later developed intraventricular haemorrhage (IVH) and spastic cerebral palsy on follow-up.

It is possible for FMH to occur late at the third trimester leading to detrimental effect. The fact that FMH can occur without antecedent risk factors underscores the importance of further research, and a high index of suspicion.