Fetomaternal hemorrhage (FMH) is a common obstetrical occurrence most often associated with small volumes of blood transferred across the placenta. Fetomaternal hemorrhage (FMH) is a poorly understood condition in which there is a transfer of fetal blood to the maternal circulation. It. Fetomaternal hemorrhage (FMH) refers to the passage of fetal blood into the maternal circulation before or during delivery. The incidence of.
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Case Reports in Obstetrics and Gynecology
Antenatal fetomaternal hemorrhage is a pathological condition with a fetomaternal hemorrhage spectrum of clinical variation. If untreated, the effects of fetomaternal hemorrhage can be catastrophic, potentially resulting in cardiac failure, hydrops, hypovolemic shock, intrauterine demise, neonatal death, neurologic injury, cerebral palsy or persistent pulmonary hypertension [ 2 ].
Case Report An eighteen-year-old primipara with an uneventful 39 fetomaternal hemorrhage pregnancy was referred to our emergency department for skin pruritus. At admission she mentioned reduced perception of fetal movements during the previous 6 hours. There was no history of abdominal trauma and blood pressure was normal.
It was decided to admit the patient for fetal surveillance. Maternal work up included hemogram, biochemistry panel, infection screening, blood group confirmation with indirect Coombs and Kleihauer-Betke test.
Fetal-maternal haemorrhage - Wikipedia
Placental pathological examination demonstrated edematous villi and the presence of numerous erythrocytic precursors with moderate to severe erythroblastosis. He was discharged from the hospital on the fetomaternal hemorrhage day with short term follow-up at our pediatrics outpatient clinic.
Discussion Fetomaternal hemorrhage was first established as a clinical entity during the s and s [ 5 ]. Massive FMH greater than 30ml occurs in only about 3 of fetomaternal hemorrhage [ 6 ]. The volume of blood loss required to affect the fetus is variable and is related to the cause and to whether the loss is acute or chronic [ 7 ].
It has not been shown to directly correlate with perinatal morbidity or mortality [ 5 ]. As mentioned above, although various risk fetomaternal hemorrhage are identified, most cases occur without any identifiable cause fetomaternal hemorrhage 7 ].
Abnormal pregnancy[ edit ] Causes of increased foetal-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found.
Foetal-maternal haemorrhage is one cause fetomaternal hemorrhage intrauterine death IUD.
Definitions of FMH relying upon a percentage of fetal blood lost to the maternal circulation have also proven problematic since normal values for fetal blood volume fetomaternal hemorrhage not fetomaternal hemorrhage been determined for various gestational ages [ 910 ].
FMH is hypothesized to occur via disruption of the placental trophoblast, leading to entry of fetal erythrocytes into the maternal circulation. A number of obstetrical events have been associated with FMH including external cephalic version, amniocentesis, abdominal trauma, placental abruption, placental tumors, and manual removal of the placenta [ 11 — 21 ].
Often, however, FMH occurs without a precipitating factor.
Fetomaternal Hemorrhage: A Review after a Case Report | OMICS International
In a review of cases with FMH greater than 50 mL, Giacoia identified cases that did not have an antecedent triggering event [ 2 ].
Fetomaternal hemorrhage, decrease or absence of fetal movement was the most common antenatal presentation of FMH [ 2 ].
Fetomaternal hemorrhage clinical findings associated with FMH included neonatal anemia, stillbirth, hydrops fetalis, nonreassuring fetal heart rate tracing, intrauterine growth restriction, and fetal tachyarrythmias.
Several diagnostic modalities for FMH have been described. First described by Kleihauer et al.
Often referred to as the Kleihauer-Betke KB stain, this test is based on the fetomaternal hemorrhage that fetal hemoglobin is resistant to acid elution compared to adult hemoglobins. Following incubation in an acid based solution, a small sample of maternal venous blood is stained with erythrosine B.
Erythrocytes containing fetal hemoglobin fetomaternal hemorrhage red while adult red blood cells are colorless. The number of fetal cells is then counted and reported as a percentage of the amount of adult cells. Furthermore, underestimation fetomaternal hemorrhage occur as a result of diminished fetal hemoglobin that sometimes occurs in fetal red blood cells.
Overestimation of FMH may also occur if a disproportionate number of adult red blood cells contain fetal hemoglobin, as is seen in cases of hereditary persistence of fetal hemoglobin, sickle-cell anemia, and beta thalassemia trait.
There was no history of pain, trauma or vaginal bleeding.