Massive fetomaternal hemorrhage preceded by decreased fetal movement and a nonreactive fetal heart rate pattern.
BACKGROUND
Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern.


METHODS
Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively.


CONCLUSIONS
A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.
Kosasa
T S
TS
Department of Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine, Honolulu.
Ebesugawa
I
I
Nakayama
R T
RT
Hale
R W
RW
D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology*; D005324:Fetal Movement; D005331:Fetomaternal Transfusion; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy