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Massive Pontine Hemorrhage by Dual Injection of Autologous Blood
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Massive fetomaternal hemorrhage: A case report.

Victoria Weinhold1, Susanne Rauber1, Elsa Hollatz-Galuschki1

  • 1Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Germany.

Zeitschrift Fur Geburtshilfe Und Neonatologie
|January 29, 2024
PubMed
Summary
This summary is machine-generated.

An abnormal fetal heart rate (cardiotocography) and elevated middle cerebral artery peak systolic velocity indicated massive fetomaternal hemorrhage. Prompt diagnosis and treatment, including intrauterine transfusions, led to a healthy infant.

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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.