Fetomaternal hemorrhage complicated pregnancy: risks, identification, and management

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Perinatal Medicine

Background:

• Massive fetomaternal hemorrhage (FMH) poses severe risks despite advances in perinatal care.
• Nonspecific clinical signs and varying definitions contribute to underdiagnosis and underestimation of FMH.
• Adverse outcomes in massive FMH have not improved, highlighting a critical gap in obstetric and neonatal management.

Purpose of the Study:

• To review literature on clinical features and risk factors of massive FMH.
• To raise awareness among obstetricians and pediatricians about this severe obstetrical issue.
• To propose a simplified flowchart for antenatal management of suspected massive FMH.

Main Methods:

• Literature review of recent studies on massive fetomaternal hemorrhage.
• Analysis of clinical features, risk factors, and diagnostic challenges.
• Development of a proposed antenatal management protocol.

Main Results:

• Massive FMH continues to have devastating consequences due to nonspecific presentation and lack of universal screening.
• Advances in diagnosing fetal anemia and intrauterine transfusions offer hope for severe cases.
• Obstetrician awareness of massive FMH remains critically low.

Conclusions:

• An internationally accepted definition and standardized management protocol for massive FMH are urgently needed.
• Structured follow-up for neonates affected by massive FMH is essential.
• Establishment of an international registry for massive FMH cases is recommended.