scholarly journals Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Paul Singh ◽  
Tara Swanson
Keyword(s):  
Fetal Heart ◽  
Fetal Anemia ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Unique Case ◽  
Diastolic Velocity ◽  
Fetomaternal Hemorrhage ◽  
Ultrasound Findings ◽  
Perinatal Management ◽  
Cerebral Vascular Resistance

Introduction.Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management.Case.A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate’s initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage.Discussion.One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed.

scholarly journals Systematic Kleihauer–Betke Test after External Cephalic Version for Breech Presentation: Is It Useful?

2020 ◽  
Vol 9 (7) ◽  
pp. 2053
Author(s):  
Johanna Lemaitre ◽  
Lucie Planche ◽  
Guillaume Ducarme
Keyword(s):  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Breech Presentation ◽  
Neonatal Outcomes ◽  
External Cephalic Version ◽  
Fetal Anemia ◽  
Fetal Blood ◽  
Fetomaternal Hemorrhage ◽  
Significant Difference ◽  
Obstetrical Management

The incidence of fetomaternal hemorrhage (FMH) after external cephalic version (ECV) has been poorly reported. In this study, we evaluated the frequency of FMH, diagnosed by positive Kleihauer–Betke test (KBT), after ECV attempt and then evaluate the relevance of its routine use after procedure. A total of 282 women with a term breech presentation and who had ECV attempt were recruited from January 2014 and December 2018. After ECV attempt, women were systematically screened for FMH using KBT. Data on ECV attempt, KBT results, perinatal and neonatal outcomes were collected and compared between women with positive (cases) and negative KBT (controls) after ECV. The success rate of ECV was 22.0% (62/282). Eight women (2.9%) experienced transient fetal heart rate (FHR) abnormalities after ECV. In five (1.8%) women, KBT was positive after ECV. Obstetrical management was modified for two of these five women due to continuous positivity of KBT at day 1 and day 7 controls after ECV attempt. A cesarean section was planned 7 days earlier due to persistent high FMH on day 7 (6 mL fetal blood) in one woman and the labor was induced for persistent high FMH on day 7 (20 mL fetal blood) for another woman. No newborns have signs of fetal anemia at birth and there was no significant difference in neonatal status between two groups. FMH after ECV attempt are rare, and no negative fetal or neonatal outcomes were observed when KBT was positive, even strongly (>5 mL fetal blood). It appears that systematic KBT after attempted ECV is probably not useful.

scholarly journals Massive fetomaternal hemorrhage as a cause of severe fetal anemia

2016 ◽  
Vol 73 (11) ◽  
pp. 1068-1071
Author(s):  
Aleksandar Dobrosavljevic ◽  
Jelena Martic ◽  
Snezana Rakic ◽  
Vladimir Pazin ◽  
Svetlana Jankovic-Raznatovic ◽  
...  
Keyword(s):  
Fetal Hemoglobin ◽  
Test Case ◽  
Fetal Anemia ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Uterine Contractions ◽  
Fetomaternal Hemorrhage ◽  
Fetal Movements ◽  
Life Threatening ◽  
Red Cell Transfusion

Introduction. Fetomaternal hemorrhage (FMH) is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report. A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion. For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.

Placental Pathologic Features in Fetomaternal Hemorrhage Detected By Flow Cytometry

2017 ◽  
Vol 20 (2) ◽  
pp. 142-151 ◽  
Author(s):  
Natasha E Lewis ◽  
Laura Marszalek ◽  
Linda M Ernst
Keyword(s):  
Flow Cytometry ◽  
Vascular Pathology ◽  
Clinical Effects ◽  
Placental Pathology ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Flow Cytometric ◽  
Fetomaternal Hemorrhage ◽  
Pathologic Features ◽  
Fetal Vessels

Background Fetomaternal hemorrhage (FMH) is a poorly understood entity that can have significant clinical effects. Flow cytometry is a reliable and relatively new method for FMH diagnosis. The objective of this study was to correlate placental pathology with FMH detected by flow cytometry. Methods All patients with available placentas and FMH flow cytometric testing performed from 2009 to 2015 were retrospectively reviewed. Cases were defined as ≥0.10% fetal red blood cells (RBCs) in the maternal circulation while controls contained <0.10%. Placental findings associated with FMH were determined. Results In this study, 35 cases and 79 controls were identified. Villous dysmaturity/immaturity was significantly more prevalent among the cases compared to the controls. Placentas with villous edema and nucleated RBCs (nRBCs) in fetal vessels were associated with greater mean volumes of fetal blood in the maternal circulation. Fetal and maternal vascular pathology was more frequent in the controls. When the cases were stratified into mild (<30 mL), moderate (30 mL–100 mL), and severe (>100 mL) FMH, nRBCs, villous dysmaturity/immaturity, and villous edema were all positively correlated with increasing FMH severity. The cases were more likely than the controls to display ≥2 of these 3 features. Fetal nRBCs within fetal vessels were semi-quantified and moderate to severe numbers of nRBCs were associated with higher mean volumes of fetal blood in maternal circulation. Conclusions Villous dysmaturity/immaturity, villous edema, and nRBCs in fetal vessels, findings compatible with fetal anemia, in addition to relatively few chronic placental changes, are the most significant placental findings in FMH detected by flow cytometry.

scholarly journals Massive fetomaternal hemorrhage with a favorable neonatal outcome: a case report

2021 ◽  
Vol 8 (2) ◽  
pp. 370
Author(s):  
Mahmoud M. Osman ◽  
Eiman S. Albadani ◽  
Suzan Abdel-Hamid ◽  
Mohammed S. Alissa ◽  
Sulafa A. Hamdoun
Keyword(s):  
Neonatal Outcome ◽  
Hypovolemic Shock ◽  
Normal Growth ◽  
Fetal Distress ◽  
Severe Anemia ◽  
Perinatal Morbidity ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Emergency Cesarean ◽  
Fetomaternal Hemorrhage

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.

Effects of Intravenous Terbutaline on Maternal Circulation and Fetal Heart Activity

1990 ◽  
Vol 69 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Anders Cson Roth ◽  
Ian Milsom ◽  
Lars Forssman ◽  
Lars-Goran Ekman ◽  
Thomas Hedner
Keyword(s):  
Fetal Heart ◽  
Heart Activity ◽  
Maternal Circulation

Oxygen equilibrium properties of blood and hemoglobin of fetal and adult Weddell seals

1981 ◽  
Vol 50 (5) ◽  
pp. 999-1005 ◽  
Author(s):  
J. Qvist ◽  
R. E. Weber ◽  
W. M. Zapol
Keyword(s):  
Whole Blood ◽  
Maternal Blood ◽  
Bohr Effect ◽  
Red Cell ◽  
Fetal Blood ◽  
Maternal Circulation ◽  
Weddell Seals ◽  
Blood Ph ◽  
Ph Decrease ◽  
2,3 Dpg

Oxygen equilibria of whole blood and hemoglobins from adult and fetal Weddell seals are reported. The maternal blood shows a lower O2 affinity than the fetal blood (halfsaturation O2 tension P50 = 26.9 +/- 1.18 and 21.4 +/- 1.25 Torr, respectively, at 37 degrees C and pH 7.4), and a greater Bohr effect (delta log P50/delta pH = -0.49 and -0.31, respectively, at pH 7.4-6.8), correlated with higher red cell 2,3-diphosphoglycerate (2,3-diphosphoglycerate (2,3-DPG) concentrations (6.45 +/- 0.81 mmol.1-1, compared to 2.65 +/- 0-42 mmol.1-1 in the fetus). Both the maternal and fetal erythrocytes contain two major and two minor hemoglobin components occurring in the same ratio and the 2,3-DPG-free whole hemolysates, as well as the isolated major components from each stage, show the same oxygenation properties, ascribing the whole-blood differences to the higher adult DPG levels. A 2,3-DPG effect also appears to account for the disparity in the Bohr effects, which will favor unloading of O2 from the maternal circulation during diving as maternal and fetal blood pH decrease in parallel.

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