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Massive fetomaternal hemorrhage

L F Akanli1, N E Cohen-Addad, N V Malabanan

  • 1New York Medical College, Valhalla, USA.

American Journal of Perinatology
|May 1, 1997
PubMed
Summary

Massive fetomaternal hemorrhage in a newborn caused severe anemia and brain hemorrhages. Despite intensive care, the infant experienced significant developmental delays and neurological deficits.

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Area of Science:

  • Neonatal Medicine
  • Perinatal Hematology
  • Pediatric Neurology

Background:

  • Fetomaternal hemorrhage (FMH) is a significant cause of fetal distress and neonatal morbidity.
  • Massive FMH can lead to severe fetal anemia, hydrops fetalis, and intrauterine fetal demise.
  • Accurate diagnosis and timely management are crucial for improving neonatal outcomes.

Purpose of the Study:

  • To report a rare case of massive fetomaternal hemorrhage in a full-term newborn.
  • To highlight the clinical presentation, diagnostic findings, and sequelae of severe fetal anemia due to FMH.
  • To emphasize the importance of recognizing subtle signs of FMH in neonates.

Main Methods:

  • Case report of a full-term newborn presenting with signs of severe fetal distress and anemia.
  • Antenatal monitoring included nonstress test and biophysical profile assessment.
  • Postnatal evaluation involved physical examination, complete blood count, and Kleihauer-Betke stain for fetal-maternal red blood cell transfer.
  • Cranial imaging (ultrasound or MRI) was utilized to detect intracranial hemorrhages.

Main Results:

  • The newborn presented with extreme pallor, hypotonia, hepatosplenomegaly, and ascites.
  • Initial hemoglobin was critically low at 2.2 g/dL.
  • Kleihauer-Betke stain revealed a massive fetomaternal hemorrhage (27.6%), the highest reported level.
  • Cerebral hemorrhages (right temporal and cerebellar) were identified.
  • The infant developed severe developmental delay and asymmetric double hemiplegia.

Conclusions:

  • Massive fetomaternal hemorrhage can result in profound fetal anemia and significant neurological injury.
  • Early recognition of decreased fetal movements and abnormal fetal testing is critical.
  • Prompt diagnosis and management of FMH are essential to mitigate severe neonatal complications and long-term sequelae.

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