1/20. Massive fetomaternal hemorrhage: how long should children with good evolution be controlled? A case report.We report on a term infant with a severe fetomaternal hemorrhage that caused a serious anemia that was surmounted after several transfusions. After the initial complications, such as persistent pulmonary circulation, severe anemia and thrombocytopenia, the outcome was good. We discuss the importance of a long-term follow-up of affected children, as well as their mothers. No clear parameters for a real prognosis are available. A follow-up is needed in order to detect possible complications in neurological development.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
2/20. anemia due to massive chronic foetomaternal hemorrhage.We report a case of massive chronic foetomaternal hemorrhage. The labor course was uncomplicated. The newborn presented with pallor. tachypnea, and moderate hepatosplenomegaly. The initial hemoglobin was 6.5 g/dl. The Kleihauer-Betke stain on a maternal blood sample was 12%, which is equivalent to 540 ml of fetal blood in the maternal circulation. A clot in the umbilical vein was demonstrated sonographically. The possible association of foetomaternal hemorrhage with umbilical vein thrombosis is discussed.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
3/20. Microchimerism in a female patient with systemic lupus erythematosus.Systemic lupus erythematosus (SLE) is a serious multisystem disease that has a striking propensity to affect women. The cause of SLE remains elusive. Fetomaternal cell trafficking, or the passage of fetal cells into the maternal circulation, is now a well-established phenomenon. In addition, fetal cells have been implicated in the development of preeclampsia and in the pathogenesis of scleroderma. We undertook this study to determine whether fetomaternal cell trafficking might also be involved in pathogenic processes in SLE. fluorescence in situ hybridization analysis was performed using X and y chromosome-specific probes on affected and unaffected tissue obtained at autopsy from a woman who had previously given birth to 2 males and who had died of complications of SLE. The goal of the analysis was to detect the presence of male cells of putative fetal origin. Male cells were found in every histologically abnormal tissue type that was examined, but were not found in histologically normal tissue. These data suggest that fetal cells may be associated with SLE. It is unclear whether their presence may be related to disease causation, an effect of disease progression, or unrelated to disease pathology. However, this case study is an important step toward understanding the potential relationship between fetomaternal cell trafficking and SLE pathology.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
4/20. Doppler sonography for predicting fetal anemia caused by massive fetomaternal hemorrhage.Fetomaternal hemorrhage (FMH) can cause severe anemia in the fetus. Untreated, this may cause hydrops or even fetal death. However, correct diagnosis of FMH followed by blood transfusion can prevent these life-threatening consequences. We describe two cases in which fetal anemia was suspected because of maternal reporting of decreased or absent fetal movements, the detection of a sinusoidal heart rate pattern and increased blood flow velocities of the middle cerebral artery and umbilical vein. Together with the Betke-Kleihauer test showing fetal cells in the maternal circulation, this led to the correct diagnosis of severe fetal anemia caused by FMH. A cesarean section was performed within a few hours. Both neonates were severely anemic and received immediate blood transfusions. They are currently alive and well.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
5/20. autopsy findings in a series of five cases of fetomaternal haemorrhages.AIMS: Fetal blood cells enter the maternal circulation in up to 95% of pregnancies, but usually in minute volumes. Haemodynamically significant fetomaternal haemorrhage (FMH) is a much rarer event reported in approximately 1 in 2800 pregnancies. Most of the literature on this phenomenon emphasises the clinical aspects, and there is no comprehensive description of the autopsy findings. We present a series of five fatal FMH. The aim of this series is to highlight some of the autopsy findings that may prompt consideration of a diagnosis of FMH and lead to appropriate confirmatory testing and counselling of the affected couple. methods: The five cases were referred to the Children's Hospital at Westmead for full autopsy. A Kleihauer-Betke test was performed on the mother's blood within one week of delivery in each case. RESULTS: The infants ranged in age from 27 to 40 weeks gestation (mean 36.6 weeks) with a mean birth weight of 2793 g. The estimated volumes of fetal blood lost ranged from 443 to 104 mL (mean loss 243 mL). The estimated percentage of fetal blood volume loss was an average of 107% (i.e., greater than the entire blood volume of the fetus). No other causes of hydrops were identified. pallor was often noted, and in most cases the autopsies were markedly bloodless with large vessels collapsed. Where the brain:liver ratio could be applied, two fetuses showed a mild increase in ratio, while one infant showed moderate growth restriction with a ratio of 6.2:1 (normal ratio 2.8:1 on non-macerated fetuses over 28 weeks gestation). Placental abnormalities included thrombosis of the umbilical vein and intervillous 'haematomas' in two cases. The most striking microscopic feature was the presence of intravascular nucleated RBC within virtually all organs. Placental intervillous (i.e., within the maternal vascular compartment) nucleated red blood cells were also seen in all cases. CONCLUSIONS: The autopsy findings of FMH can be subtle and easily overlooked unless a high index of suspicion is maintained. The most reliable autopsy features are pallor, subcutaneous oedema or serous effusions, and intravascular nucleated red blood cells (RBC) in organs or more specifically in the placental intervillous space. In all cases of unexplained fetal death a Kleihauer-Betke test should be performed.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
6/20. Massive fetomaternal hemorrhage and oxytocin contraction test: case report and review.We present a case of a nulliparous woman who underwent oxytocin contraction test because of abnormal cardiotocograph. She delivered a severely anemic neonate due to severe fetomaternal hemorrhage. Fetal ultrasonography and Doppler studies of the umbilical arteries may not be helpful, while its worthy to perform flow cytometry for detection of fetal cells in maternal circulation when there is strong clinical suspicion. Management of massive fetomaternal hemorrhage requires immediate delivery by Caesarean section if the gestational age is suitable. Alternatively, for very premature fetuses could be used serial fetal intravascular transfusions if there are the necessary facilities and experienced personnel.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
7/20. Persistent fetal hemoglobin in maternal circulation complicating the diagnosis of fetomaternal hemorrhage.BACKGROUND: Transplacental hemorrhage can be life threatening to a fetus and has important maternal treatment implications. In contrast, hereditary persistence of fetal hemoglobin is a condition that has little consequence. The Kleihauer-Betke test, which is routinely used to document transplacental hemorrhage, will be positive in either case. CASES: We report two cases in which maternal persistence of fetal hemoglobin was unknown and led to the erroneous diagnosis of fetomaternal hemorrhage. These cases highlight both the limitations of the Kleihauer-Betke test and the role of flow cytometry in diagnosing fetomaternal hemorrhage. CONCLUSION: The use of flow cytometry can clarify Kleihauer-Betke test results when there is known maternal persistence of fetal hemoglobin and can more precisely quantify a fetomaternal hemorrhage for accurate Rh immune globulin dosing.- - - - - - - - - - ranking = 4keywords = circulation (Clic here for more details about this article) |
8/20. Massive antenatal fetomaternal hemorrhage: evidence for long-term survival of fetal red blood cells.BACKGROUND: Massive fetomaternal hemorrhage (FMH) can lead to life-threatening anemia. Quantification based on flow cytometry with anti-hemoglobin F (HbF) is applicable in all cases but underestimation of large fetal bleeds has been reported. A large FMH from an ABO-compatible fetus allows an estimation of the life span of fetal red blood cells (RBCs) in the maternal circulation. CASE REPORT: The mother went to the obstetrician twice antepartum owing to symptoms assumed to be preeclampsia; that, however, was not found. She later delivered by cesarean section owing to diminished fetal movements. No fetal weight gain was observed during the last 2 weeks of pregnancy. STUDY DESIGN AND methods: Fetal RBCs were quantified by flow cytometry with anti-HbF, anti-Fy(a), anti-s, and anti-Jk(b) on a regular basis. RESULTS: The infant had anemia at delivery and an FMH was determined to be 314 /- 17 mL ( /- SD) of whole blood. It is assumed that the two antenatal visits were associated with the FMH. Postpartum follow-up showed that fetal RBCs in the maternal circulation were detectable with anti-HbF up to 119 days. Quantification by flow cytometry based on anti-HbF was in agreement with quantification based on anti-Fy(a), anti-s, and anti-Jk(b), although they were less sensitive. CONCLUSION: ABO-compatible fetal RBCs from an FMH had a life span in the maternal circulation close to that of adult RBCs.- - - - - - - - - - ranking = 3keywords = circulation (Clic here for more details about this article) |
9/20. Severe anemia in a newborn due to massive fetomaternal hemorrhage: report of one case.We report a case of a newborn with unexpected severe anemia. A woman, at 38 5/7 weeks of gestational age, presented with decreased fetal movement. A sinusoidal fetal heartbeat waveform and late deceleration pattern on fetal monitoring strengthened the decision for emergent cesarean section. Using the frequency of fetal movement and the fetal heart monitoring pattern, together with detecting fetal hemoglobin in maternal blood circulation by the Kleihauer-Betke test and hemoglobin electrophoresis, fetomaternal hemorrhage can be detected earlier and provide for better fetal outcomes.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
10/20. Case report of massive fetomaternal hemorrhage and a guideline for acute neonatal management.Massive fetomaternal hemorrhage resulting in profound anemia and shock is associated with high perinatal morbidity and mortality. Although diagnosis before delivery is difficult, the clinical index of suspicion rises when a woman presents with history of decreased or absent fetal movements and antenatal monitoring shows a sinusoidal rhythm strip. The diagnosis can be made quickly by demonstration of fetal red blood cells in the maternal circulation and there is consistent recommendation in the literature to immediately order a Kleihauer-Betke test. Clinical manifestations of a fetomaternal hemorrhage depend on the volume of blood lost and the rate with which it occurred. The severely compromised anemic infant indicative of acute hemorrhage will be pale with gasping respirations and signs of circulatory shock. Immediate intervention with volume resuscitation is crucial for optimal outcome. This article describes a patient with massive fetomaternal hemorrhage and subsequent devastating neonatal complications. The focus of this article is to provide clinical guidance for the management and care of the infant affected by profound anemia.- - - - - - - - - - ranking = 1keywords = circulation (Clic here for more details about this article) |
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