Massive fetomaternal hemorrhage: A case report.

Area of Science:

• Maternal-Fetal Medicine
• Fetal Cardiology
• Neonatal Hematology

Background:

• Cardiotocography (CTG) and middle cerebral artery peak systolic velocity (MCA-PSV) are key fetal surveillance tools.
• Fetomaternal hemorrhage (FMH) can lead to severe fetal anemia and adverse outcomes.
• Incidental findings during pregnancy monitoring require thorough investigation.

Purpose of the Study:

• To report a case of massive fetomaternal hemorrhage (FMH) incidentally detected by abnormal fetal surveillance.
• To highlight the diagnostic utility of flow cytometry (FC) in identifying FMH.
• To describe the management and outcome of a fetus with severe anemia due to FMH.

Main Methods:

• Utilized cardiotocography (CTG) and middle cerebral artery peak systolic velocity (MCA-PSV) for fetal assessment.
• Employed flow cytometry (FC) for definitive diagnosis of fetomaternal hemorrhage (FMH).
• Performed serial fetal blood sampling (FBS) to monitor fetal hemoglobin levels and conducted intrauterine transfusions (IUTs).

Main Results:

• An abnormal CTG pattern and elevated MCA-PSV were incidental findings in an otherwise uncomplicated pregnancy.
• Flow cytometry confirmed massive fetomaternal hemorrhage (FMH) as the underlying cause.
• The fetus experienced severe anemia, necessitating multiple intrauterine transfusions (IUTs) and resulting in preterm delivery.

Conclusions:

• Massive FMH can present insidiously with non-specific fetal surveillance abnormalities.
• Flow cytometry is crucial for diagnosing FMH when suspected.
• Timely intervention with IUTs and preterm delivery can lead to favorable neonatal outcomes despite severe fetal anemia.