Cases reported "Fetomaternal Transfusion"

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1/7. Idiopathic chronic fetomaternal haemorrhage resulting in hydrops--a case report.

    INTRODUCTION: We report a case of idiopathic chronic fetomaternal haemorrhage (FMH) that developed in the late trimester. CLINICAL PRESENTATION: The patient presented with decreased fetal movement at 38 weeks gestation. Antenatal follow-up was uneventful with normal serial ultrasound performed at 22 and 35 weeks. Prior to delivery, the cardiotocography (CTG) was abnormal with decreased baseline variability and late deceleration. Emergency lower segment caesarean section was performed. Upon delivery, a hydropic neonate with a haemoglobin level of 3.9 g/dL was noted. The Kleihauer-Betke test was positive, confirming FMH. OUTCOME: The neonate later developed intraventricular haemorrhage (IVH) and spastic cerebral palsy on follow-up. DISCUSSION: It is possible for FMH to occur late at the third trimester leading to detrimental effect. The fact that FMH can occur without antecedent risk factors underscores the importance of further research, and a high index of suspicion.
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2/7. 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.
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3/7. Doppler sonography of the fetal middle cerebral artery in the management of massive fetomaternal hemorrhage.

    Massive fetomaternal hemorrhage (FMH) is a rare complication in pregnancy that may cause hydrops or can even be life-threatening for the fetus. We report on the case of a 19-year-old gravida I, para 0, who presented to our clinic at 32 weeks of gestation due to decreased fetal movements. The initial fetal heart rate tracing at admission showed a sinusoidal pattern without decelerations. The ultrasound examination performed immediately described a normally developed fetus with normal amounts of amniotic fluid and without abnormities of the placental structure. Doppler sonography of the fetal middle cerebral artery gave rise to the strong suspicion of fetal anemia, so that a cordocentesis was prepared for potential intrauterine blood transfusion. Meanwhile, the rate of fetal hemoglobin (HbF) cells in the maternal blood was found to be markedly increased with 66 per thousand. Correspondingly, cardiotocographic findings worsened with repeated decelerations, thus an immediate cesarean section was performed based on the suspected diagnosis of an acute FMH. A fetus weighing 1,860 g was delivered, who had severe anemia with hemoglobin level of 4.0 g/dl. After a direct blood transfusion, HbF levels normalized rapidly, the fetus stabilized, and a normal recovery has thus far been reported. The presented case demonstrates the successful and straightforward diagnosis, as well as the management of a case of severe FMH and illustrates the special value of Doppler sonography in this context.
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4/7. Chronic massive fetomaternal hemorrhage: a case report.

    We report a case of massive chronic fetomaternal hemorrhage with remarkable fetal compensation. The labor course was complicated by a fetal heart rate pattern showing decreased long- and short-term variability and the eventual development of persistent late decelerations. The fetal scalp blood pH and cord blood pH values were normal. A living male infant was delivered by cesarean section for persistent late decelerations. A Kleihauer-Betke stain on a maternal blood sample was positive at 14.5%, which is equivalent to 700 mL of fetal blood in the maternal circulation.
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5/7. Acute feto-maternal transfusion--diagnostic considerations.

    A sinusoidal fetal heart rate pattern followed by severe deceleration was encountered in a fetus at 39 weeks' gestation during antepartum fetal nonstress testing. The only indication for fetal monitoring was a maternal complaint of cessation of fetal movements. The abdominally-delivered newborn was found to be severely anaemic and the cord was tightly wrapped round its body. A pathophysiological mechanism for massive feto-maternal transfusion is suggested. Various laboratory tests were utilized to identify the condition, quantitate the amount of transfusion, and estimate the time of its occurrence. Globin synthesis studies in maternal blood indicated that a significant fetal blood loss had occurred within 24 hours of delivery. The significance of these findings as applied to the clinician is discussed.
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6/7. Identification of acute transplacental hemorrhage in a low-risk patient as a result of daily counting of fetal movements.

    In this report, we describe a case of acute, massive fetomaternal hemorrhage that was detected during the 32nd week of pregnancy by maternal perception of decreased fetal movement and suggestion of a sinusoidal heart rate pattern. Additional evaluation revealed an abnormal biophysical profile (2 of 10) and intermittent late decelerations. Because of the substantially decreased fetal reserve, cesarean section was emergently performed. A 1,880-g female infant was delivered. She had an initial hemoglobin concentration of 1.9 g/dl and a hematocrit of 5.7% but did well after appropriate transfusion therapy. This case confirms the importance of daily counting of fetal movements in low-risk patients. In addition, it emphasizes that early diagnosis and treatment of massive fetomaternal hemorrhage can improve infant survival.
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7/7. Prevention of rh isoimmunization after spontaneous, massive fetomaternal hemorrhage.

    Massive fetomaternal hemorrhage has been associated with numerous risk factors and can occur spontaneously. The risk is probably greater when a woman who is Rh negative has an ABO-compatible fetus. We report the case of a gravid, A-negative unsensitized patient who came to the hospital at term complaining of decreased fetal movement over the previous 24 hours. During evaluation, the fetal heart rate was found to have decreased beat-to-beat variability and repetitive late decelerations, and the mother was delivered of a 3,005 gA-positive neonate (by cesarean section) with a hemoglobin level of 2.9 g/dL. An acid elution test showed 400 mL of fetal blood in the maternal circulation, and the patient received 23 ampules (6,900 micrograms) of Rh immune globulin postpartum. The patient's condition was observed for 156 days after delivery; she did not become sensitized to the Rh factor. A massive fetomaternal hemorrhage can occur without any antecedent risk factors, with a risk of subsequent morbidity to the neonate. Sensitization can be prevented by prompt administration of adequate amounts of Rh immune globulin.
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