Sinusoidal heart rate patterns as a manifestation of massive fetomaternal hemorrhage in a monochorionic-diamniotic twin pregnancy: a case report.
OBJECTIVE
A case of fetomaternal hemorrhage (FMH) in monochorionic twins is reported.


METHODS
Case report.


RESULTS
The patient felt a decrease in fetal movements at 32 gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in both fetuses. The fetal hemoglobin level in maternal blood was 6.6% (normal 0.0-1.0%). Since the patient was diagnosed with massive FMH, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both infants, based on red blood cell count, hemoglobin concentration, and hematocrit of 86 x 10 and 85 x 10(4)/mm(3) (normal 376-456 x 10(4)/mm(3)), 3.1 g/dl each (normal 10.9-13.5 g/dl), and 10.7 and 10.4% (normal 32.2-41.2%), respectively. Severe anemia may develop in both fetuses following massive FMH in monochorionic twins. As such, if abnormal circulation is detected in 1 monochorionic twin, the other fetus will also require special attention.
Division of Obstetrics, Department of Perinatology, National Center for Child Health and Development, Setagaya, Tokyo, Japan. watanabe-n@ncchd.go.jp
Noriyoshi
N
Watanabe
Seung Chik
SC
Jwa
Nobuaki
N
Ozawa
Haruhiko
H
Sago
D000328:Adult; D002585:Cesarean Section; D004200:Diseases in Twins / Q000175:diagnosis* / Q000503:physiopathology; D004906:Erythrocyte Count; D005260:Female; D005319:Fetal Hemoglobin / Q000032:analysis; D005331:Fetomaternal Transfusion / Q000175:diagnosis* / Q000503:physiopathology; D006340:Heart Rate, Fetal; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000503:physiopathology
D005319:Fetal Hemoglobin