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Chronic massive fetomaternal hemorrhage: a case report.

C Willis1, C S Foreman

  • 1Department of Obstetrics and Gynecology, Truman Medical Center, University of Missouri-Kansas City School of Medicine.

Obstetrics and Gynecology
|March 1, 1988
PubMed
Summary

This case study details massive chronic fetomaternal hemorrhage where the fetus compensated remarkably despite concerning fetal heart rate patterns during labor. A healthy infant was delivered via C-section after significant fetal blood loss into the maternal circulation.

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Obstetrics

Background:

  • Fetomaternal hemorrhage (FMH) involves fetal blood transfer to the maternal circulation.
  • Chronic FMH can lead to fetal anemia and distress.
  • Diagnosis often relies on clinical suspicion and laboratory tests like the Kleihauer-Betke stain.

Observation:

  • A laboring patient presented with non-reassuring fetal heart rate patterns, including decreased variability and late decelerations.
  • Fetal scalp and cord blood pH levels were within normal limits.
  • A Kleihauer-Betke stain revealed 14.5% fetal erythrocytes in maternal blood, indicating approximately 700 mL of fetal blood loss.

Findings:

  • Massive chronic fetomaternal hemorrhage occurred with significant fetal blood volume loss.

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  • The fetus demonstrated remarkable compensation despite the substantial hemorrhage.
  • Normal fetal blood gas values were observed despite the estimated blood loss.

    • Implications:

    • This case highlights the potential for significant fetal compensation in cases of massive chronic fetomaternal hemorrhage.
    • It underscores the importance of considering FMH in the differential diagnosis of non-reassuring fetal heart rate patterns, even with normal blood gas values.
    • Effective management requires prompt recognition and intervention, often involving cesarean delivery.