Figure 1 - uploaded by Aurora Espinosa
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Microscopy field of the Kleihauer-Betke test performed before the caesarean section. Arrows indicate the presence of fetal erythrocytes on a background of pale, maternal erythrocytes. The FMH was estimated to be approximately 287 mL.
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... Recently, flow cytometry analysis has been developed to detect HbF, and it correlates well with the Kleihauer-Betke test. 2 Massive FMH may be associated with an adverse neurological outcome; and the prognosis can be improved by early diagnosis, timely delivery, and adequate neonatal blood transfusion. But, in the case of a premature fetus, intrauterine transfusion can be performed. ...
Fetomaternal hemorrhage (FMH) indicates the passage of fetal blood into the maternal circulation. In most pregnancies, small amounts of fetal erythrocytes can cross over to the maternal circulation without causing problems for the fetus. On rare occasions, massive FMH can occur and causes profound fetal and neonatal anemia, which associate with high perinatal morbidity and mortality. Herein, we present a case of massive fetomaternal hemorrhage and a favorable neonatal outcome. The infant was a late preterm male born via an emergency cesarean section due to fetal distress, he had severe anemia, and hypovolemic shock. He was successfully resuscitated and the anemia was adequately corrected through three PRBCs transfusions. Acute massive fetomaternal hemorrhage was diagnosed based on a positive Kleihauer-Betke test on the mother’s blood. The infant had normal growth and normal developmental milestones in the subsequent visits up to the age of 18 months.
Fetomaternal hemorrhage (FMH) is a known cause of neonatal anemia due to fetal blood loss to the maternal circulation, occurring when the maternal-fetal barrier is disrupted. Several causes must be considered, although in most cases the etiology remains unknown. Intraplacental choriocarcinoma (ICC) is a rare entity and has been related with massive FMH, intrauterine fetal demise, severe neonatal anemia and metastatic choriocarcinoma in both mother and infant. There are 25 cases of histopathologically confirmed ICC complicated with FMH described in the literature. Because FMH occurs unexpectedly and the majority of patients with ICC are asymptomatic, this diagnosis may be missed. Once FMH is confirmed, underlying malignancy should be kept in mind. The authors present a case report of severe neonatal anemia following FMH related to ICC and highlight the importance of serum β-hCG monitoring in cases of massive FMH.
