Severe fetomaternal hemorrhage: a review

Area of Science:

• Perinatal Medicine
• Maternal-Fetal Medicine
• Neonatology

Background:

• Fetomaternal hemorrhage (FMH) is a significant complication of pregnancy.
• Large FMH (> 50 dL) can lead to severe fetal distress and adverse outcomes.
• Understanding the clinical presentation and outcomes of large FMH is essential for timely intervention.

Purpose of the Study:

• To review the etiology, clinical presentation, obstetrical antecedents, and outcomes of pregnancies complicated by large fetomaternal hemorrhage (FMH).
• To identify early indicators and assess the effectiveness of interventions for large FMH.

Main Methods:

• Comprehensive literature review using MEDLINE (1966-present) and manual searches (pre-1966).
• Analysis of 134 reported cases of infants with FMH > 50 dL.
• Evaluation of variables including birth weight, gestational age, fetal heart rate patterns, fetal body movements, and hemoglobin levels.

Main Results:

• Decreased or absent fetal body movements (FBM) and sinusoidal heart rate (SHR) patterns were identified as late signs of FMH.
• SHR patterns were associated with decreased FBM in 39.3% of cases.
• Intrauterine transfusions (IUT) were performed in 9 cases with 8 survivors, suggesting potential benefit.

Conclusions:

• Decreased FBM, SHR patterns, and hydrops fetalis are late indicators of FMH, necessitating improved early detection strategies.
• The role of IUT requires further definition, and long-term neurodevelopmental outcomes for affected infants need comprehensive follow-up.