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.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905.
R H
RH
Heise
J T
JT
Van Winter
P L
PL
Ogburn
D000208:Acute Disease; D000328:Adult; D005260:Female; D005323:Fetal Monitoring; D005324:Fetal Movement; D005331:Fetomaternal Transfusion / Q000175:diagnosis*; D006340:Heart Rate, Fetal; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis*; D011263:Pregnancy Trimester, Third