Tachycardia as the sole fetal heart rate abnormality after funipuncture.
BACKGROUND
Fetal bradycardia is a common complication of funipuncture. We present a case of fetal exsanguination in which fetal tachycardia was the sole fetal heart rate abnormality.


METHODS
Funipuncture was performed at 32 weeks' gestation for evaluation of Rh isoimmunization. A persistent fetal tachycardia ensued and, although there was no immediate ultrasound evidence of bleeding, repeat ultrasonography revealed active bleeding at the puncture site. A neonate with an initial hematocrit of 42% was delivered by cesarean. Despite aggressive replacement of blood products, a repeat hematocrit was only 35% and a severe, persistent coagulopathy ensued. The newborn died 18 hours after delivery. Autopsy findings were consistent with neonatal coagulopathy.


CONCLUSIONS
Although fetal bleeding is usually a common, relatively benign complication of funipuncture, streaming may not always be detected on ultrasonographic examination. Our case demonstrates that fetal tachycardia may be the only sign of fetal hemorrhage.
Seligman
S P
SP
Department of Obstetrics and Gynecology, New York University School of Medicine, New York, USA.
Young
B K
BK
D000328:Adult; D017218:Cordocentesis / Q000009:adverse effects*; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006340:Heart Rate, Fetal; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis; D011677:Punctures / Q000009:adverse effects; D012203:Rh Isoimmunization / Q000175:diagnosis; D013610:Tachycardia / Q000209:etiology*