Ongoing fetomaternal hemorrhage treated by serial fetal intravascular transfusions

Nonimmune hydrops secondary to atraumatic, massive fetomaternal hemorrhage was diagnosed at 33.5 weeks' gestation by a maternal Kleihauer-Betke stain, confirmed by funipuncture. The initial fetal hematocrit was 6.5%. Kleihauer-Betke testing revealed a fetomaternal hemorrhage of approximately 230 mL. Fetal karyotype, total immunoglobulin M, and liver function tests were normal. Maternal parvovirus serology was negative. Treatment with two fetal intravascular transfusions provided only transient improvement because the fetomaternal hemorrhage proved to be unrelenting.