Severe neonatal anemia possibly caused by spontaneous cephalic version, with excellent outcome--a case report

A 29-year-old primipara with breech presentation had a spontaneous cephalic version a few days before her admission. She was hospitalised because of a sudden decrease in fetal movements perceived. During labour a sinusoidal fetal heart rate pattern was observed. The mother gave birth to a strikingly pale 3250 g weighing boy. His APGAR score was 1/5/6. Cord hemoglobin was 2.9 g/dl and an acid elution test showed the presence of 9.1% fetal red cells in the maternal circulation. Following a transfusion of packed cells and total blood, the babies hemoglobin rose to above 10 g/dl. On the second day of life he developed an acute functional renal failure which responded well to fluid restriction and furosemide administration. Upon discharge, 10 days after birth, the physical and neurological examination were normal. At present time the child is two years old and thriving well. Anemia in the newborn due to occult blood loss may be the result of bleeding of the fetus into the maternal circulation. The incidence of a massive transplacental blood loss is increased by traumatic amniocentesis, by external cephalic version and during cesarian section. As illustrated by the present case, spontaneous cephalic version may possibly account for another cause of feto-maternal transfusion resulting in severe neonatal anemia. Severe anemia at birth secondary to an acute and massive feto-maternal hemorrhage is commonly associated with a poor prognosis. Under such conditions immediate re-expansion of the blood volume proved to be life saving.