title: Fetomaternal hemorrhage complicated pregnancy: risks, identification, and management.
abstract: OBJECTIVE
  This article aims not only to review recent literature about the clinical features of massive fetomaternal hemorrhage (FMH) and identification of risk factors, but also to alert obstetricians and pediatricians to this underdiagnosed and underestimated severe obstetrical issue. In addition, a simplified flow chart for the antenatal management of suspected FMH is proposed.
  
  
  RESULTS
  Improvements in obstetrical and neonatal care have decreased perinatal morbidity and mortality and the rate of stillbirth. Unfortunately, because of the nonspecific signs on presentation, adverse outcome associated with massive FMH has not followed this trend and still has devastating consequences. As even the definition varies among publications and there is lack of universal screening, the real nature still remains obscure. Improvements in the diagnosis of fetal anemia, laboratory and intrauterine transfusion techniques, and the implementation of prenatal and postnatal neuroprotection give some hope for the better outcome in the most severe cases. Unfortunately, obstetricians' awareness of the massive FMH remains still at an unacceptably low level.
  
  
  CONCLUSIONS
  There is an urgent need for the internationally accepted definition, standardized pregnancy management protocol, and structured follow-up of neonates from such pregnancies. We suggest the international registry of massive FMH cases.
authors: Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors: Vedran
authors: V
authors: Stefanovic
mesh_terms: D002822:Choriocarcinoma / Q000150:complications / Q000175:diagnosis; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000628:therapy; D046128:Fetal Therapies; D005331:Fetomaternal Transfusion / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis