Fetomaternal Hemorrhage: A Review after a Case Report

Fetomaternal hemorrhage consists in the transmission of fetal blood cells to the mother’s bloodstream. If it is quite common in small volumes – occurring in most pregnancies – large volumes of fetomaternal hemorrhage can have serious consequences. Some risk factors are identified, but they are not always present. Decreased perception of fetal movements is the most important clinical sign, together with a pathological NST. Prompt diagnostic and immediate obstetric cares are fundamental, as serious risks to the fetus might result from this condition. We describe the case report of an eighteen-year-old primipara, 39 weeks pregnant, who referred reduced perception of fetal movements during the previous 6 hours. There was no history of abdominal trauma. Non Stress Test (NST) showed a sinusoidal pattern and an emergent C section was performed. A male infant with 3500 gr was born with an Apgar score of 5/7/7. Fetal hemoglobin at the first hour of life was 4,4g/dl. Kleihauer-Betke test revealed 6,7% of fetal erythrocytes in the maternal bloodstream. Despite being rare, it is important to detect a massive fetomaternal hemorrhage. Fetal anemia could be suspected, but the diagnosis was only made after delivery. This case reveals the importance of keeping a high suspicion in obstetric practice, as fetomaternal hemorrhage is a rare but potentially catastrophic event for a fetus. When a massive fetal hemorrhage occurs it is crucial to promptly detect it. Immediate cesarean delivery is recommended if the infant is near-term gestation. In cases of preterm gestation, in utero transfusion can be considered to minimize the effects of fetal anemia [3]. 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].