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.
Department of Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine, Honolulu.
T S
TS
Kosasa
I
I
Ebesugawa
R T
RT
Nakayama
R W
RW
Hale
D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology*; D005324:Fetal Movement; D005331:Fetomaternal Transfusion; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy