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Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern
T S Kosasa1, I Ebesugawa, R T Nakayama
1Department of Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine, Honolulu.
Background:
Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern.
Cases:
Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively.
Conclusion:
A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.