The contribution of massive fetomaternal hemorrhage to antepartum stillbirth: a 25-year cross-sectional study.
BACKGROUND
Fatal antepartum fetomaternal hemorrhage is a relatively uncommon clinical presentation, though one that appears quickly and without warning. The pathophysiology of this disease is unclear, and the incidence does not appear to be decreasing in line with overall antepartum mortality. This study was undertaken to analyse trends in antepartum fetal death from fetomaternal hemorrhage over a 25-year period in a single maternity hospital in Dublin, Ireland.


METHODS
A cross-sectional study of 192 132 nonanomalous infants weighing 500 g or more, delivered in a single tertiary-referral university institution between 1987 and 2011. Data was compared using Fisher's exact test, univariate analysis, and Cuzick's test for trend.


RESULTS
There was no decrease in the rate of fatal fetomaternal hemorrhage over the past 25 years (p = 0.29), despite a decline in overall antepartum deaths (p = 0.0049). Fetomaternal hemorrhage accounted for 4.1% (34/828) of antepartum stillbirths. A higher proportion of these stillbirths occurred at term gestations (74%; 25/34) compared with other causes (40%; 321/794; p = 0.0003). Female infants were statistically more likely to be involved than males [odds ratio (OR) 2.33, 95% confidence interval (CI) 1.08-5.47, p = 0.02). Multiple gestations were up to six times as likely to be affected as singleton pregnancies (OR 6.52, 95% CI 1.67-18.50, p = 0.005).


CONCLUSIONS
Over the past 25 years there has been no reduction in rates of fatal fetomaternal hemorrhage. Female infants and multiple gestations remain at higher risk of antepartum death from fatal fetomaternal hemorrhage.
UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Bobby D
http://orcid.org/0000-0003-0793-9021
BD
O'Leary
Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
Colin A
http://orcid.org/0000-0003-4694-2805
CA
Walsh
Department of Haematology, National Maternity Hospital, Dublin, Ireland.
Joan M
http://orcid.org/0000-0002-2110-6969
JM
Fitzgerald
Department of Histopathology, National Maternity Hospital, Dublin, Ireland.
Paul
http://orcid.org/0000-0002-9890-4678
P
Downey
UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.|Fetal Medicine Unit, National Maternity Hospital, Dublin, Ireland.
Fionnuala M
http://orcid.org/0000-0002-3477-6494
FM
McAuliffe
D003430:Cross-Sectional Studies; D005260:Female; D005331:Fetomaternal Transfusion / Q000401:mortality*; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D007231:Infant, Newborn; D007494:Ireland / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*
Fetomaternal transfusion; fetal death; fetomaternal hemorrhage; perinatal death; pregnancy outcomes