Long-term prognosis for infants after massive fetomaternal hemorrhage.
OBJECTIVE
To evaluate the fetal, neonatal, and long-term prognosis of massive fetomaternal hemorrhage (20 mL or more).


METHODS
This series includes all patients with Kleihauer test values of 40 per 10,000 or higher over an 8-year period at two university hospitals. We examined obstetric, neonatal, and subsequent outcome data for the children.


RESULTS
During the study period, 48 patients had massive fetomaternal hemorrhage (crude incidence 1.1 per 1,000; corrected incidence for Rh-negative women 4.6 per 1,000). Six fetal deaths were observed, representing 1.6% of all fetal deaths during the period. Nine newborns (18.7%) were transferred to neonatal intensive care unit (NICU) and five (10.4%) had transfusions. Fetomaternal hemorrhages of 20 mL/kg or more significantly increased the risk of fetal death, induced preterm delivery, transfer to NICU, and neonatal anemia requiring transfusion. Long-term follow-up was not associated with neurological sequelae (0%, 95% confidence interval 0.0-11.6%).


CONCLUSIONS
When the transfused volume equals or exceeds 20 mL/kg, massive fetomaternal hemorrhage may lead to severe prenatal or neonatal complications.


METHODS
III.
Hôpital Jeanne de Flandre, Université Lille II, 1 rue Eugène Avinée, 59037 Lille Cedex, France. c.rubod@orange.fr
Chrystèle
C
Rubod
Philippe
P
Deruelle
Francoise
F
Le Goueff
Virginie
V
Tunez
Martine
M
Fournier
Damien
D
Subtil
D000293:Adolescent; D000328:Adult; D000751:Anemia, Neonatal / Q000097:blood / Q000175:diagnosis; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005331:Fetomaternal Transfusion / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies