Fetal and neonatal prognosis of massive fetomaternal hemorrhage

ObjectiveMassive fetomaternal haemorrhage (FMH) is not simply a problem of possible alloimmunization in Rh incompatibility but also endangers the fetus by massive anemization. However, little is known about the prognosis of this pathology. The aim of this study was to evaluate the fetal, neonatal and long term prognosis of massive FMH.Study designA serie of consecutive cases of massive fetomaternal haemorrhage was reviewed in 2 university establishments during a 8-year period (1996-2003). FMH was measured by using the Kleihauer-Betke test. Massive FMH was defined as bleeding of greater than 20 mL of fetal blood in the maternal circulation. In each case, the amount of bleeding was related to the estimated fetal weight at onset of the FMH. Obstetrical and neonatal data and long term outcome were studied.ResultsDuring the study period, 48 massive FMH were diagnosed (incidence was 1.1/1000). Six antepartum fetal deaths occured (1.6% of all fetal deaths). 9 newborns were admitted to the neonatal intensive care unit (18.7%) and five of them needed blood transfusion (10.4%). 30 patients were follow up (medium age of infants 57.6 months ±25.5) and no neurologic sequela was detected (0% IC95 [0.0-11.6]). FMH ≥ 20 ml/kg were significantly associated with an increased risk of fetal death, prematurity, neonatal transfer, anemia and blood transfusion.ConclusionMassive FMH is uncommon but not rare, and the prognosis is severe. When the fetomaternal transplacental hemorrhage was ≥20 ml/kg, massive FMH were associated with adverse outcome. We conclude that this volume threshold should implicate appropriate management and follow up. ObjectiveMassive fetomaternal haemorrhage (FMH) is not simply a problem of possible alloimmunization in Rh incompatibility but also endangers the fetus by massive anemization. However, little is known about the prognosis of this pathology. The aim of this study was to evaluate the fetal, neonatal and long term prognosis of massive FMH. Massive fetomaternal haemorrhage (FMH) is not simply a problem of possible alloimmunization in Rh incompatibility but also endangers the fetus by massive anemization. However, little is known about the prognosis of this pathology. The aim of this study was to evaluate the fetal, neonatal and long term prognosis of massive FMH. Study designA serie of consecutive cases of massive fetomaternal haemorrhage was reviewed in 2 university establishments during a 8-year period (1996-2003). FMH was measured by using the Kleihauer-Betke test. Massive FMH was defined as bleeding of greater than 20 mL of fetal blood in the maternal circulation. In each case, the amount of bleeding was related to the estimated fetal weight at onset of the FMH. Obstetrical and neonatal data and long term outcome were studied. A serie of consecutive cases of massive fetomaternal haemorrhage was reviewed in 2 university establishments during a 8-year period (1996-2003). FMH was measured by using the Kleihauer-Betke test. Massive FMH was defined as bleeding of greater than 20 mL of fetal blood in the maternal circulation. In each case, the amount of bleeding was related to the estimated fetal weight at onset of the FMH. Obstetrical and neonatal data and long term outcome were studied. ResultsDuring the study period, 48 massive FMH were diagnosed (incidence was 1.1/1000). Six antepartum fetal deaths occured (1.6% of all fetal deaths). 9 newborns were admitted to the neonatal intensive care unit (18.7%) and five of them needed blood transfusion (10.4%). 30 patients were follow up (medium age of infants 57.6 months ±25.5) and no neurologic sequela was detected (0% IC95 [0.0-11.6]). FMH ≥ 20 ml/kg were significantly associated with an increased risk of fetal death, prematurity, neonatal transfer, anemia and blood transfusion. During the study period, 48 massive FMH were diagnosed (incidence was 1.1/1000). Six antepartum fetal deaths occured (1.6% of all fetal deaths). 9 newborns were admitted to the neonatal intensive care unit (18.7%) and five of them needed blood transfusion (10.4%). 30 patients were follow up (medium age of infants 57.6 months ±25.5) and no neurologic sequela was detected (0% IC95 [0.0-11.6]). FMH ≥ 20 ml/kg were significantly associated with an increased risk of fetal death, prematurity, neonatal transfer, anemia and blood transfusion. ConclusionMassive FMH is uncommon but not rare, and the prognosis is severe. When the fetomaternal transplacental hemorrhage was ≥20 ml/kg, massive FMH were associated with adverse outcome. We conclude that this volume threshold should implicate appropriate management and follow up. Massive FMH is uncommon but not rare, and the prognosis is severe. When the fetomaternal transplacental hemorrhage was ≥20 ml/kg, massive FMH were associated with adverse outcome. We conclude that this volume threshold should implicate appropriate management and follow up.