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Park, Park, and Choi: Neonatal Severe Anemia Due to Massive Fetomaternal Hemorrhage
Case Report

Perinatology 2019;30(1):40-45.

Published online: 20 March 2019

DOI: https://doi.org/10.14734/PN.2019.30.1.40

Neonatal Severe Anemia Due to Massive Fetomaternal Hemorrhage

Hyoung Cheul Park, MD, Sang Kee Park, MD, Min Seon Choi, MD

Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea

Correspondence to Min Seon Choi, MD Department of Pediatrics, Chosun University College of medicine, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: +82-62-220-3293 Fax: +82-62-227-2904 E-mail: mschoi@chosun.ac.kr

Received 7 August 2018       Revised 12 September 2018       Accepted 17 October 2018

Copyright © 2019 The Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fetomaternal hemorrhage refers to the entry of fetal blood into the maternal circulation before or during delivery. Very small amount of fetal red cells are normally detectable in all pregnancies. Massive fetomaternal bleeding is very rare and even rarer is the resultant severe anemia causing early neonatal death. Especially, the bleeding occurs more than 150 mL from the fetus to the mother, defined as a massive bleeding, even though it is very rare, is known to account for more than 10% of unexplainable deaths of fetuses. Fetal blood is likely to enter the maternal circulation during all pregnancies, without apparent clinical significance in most cases. Decreased or absence of fetal movement is the most common antenatal presentation, observed in approximately 25% of all cases. We hereby report that a severe anemia and dyspnea from a newborn baby was found and that it was treated instantly right after the birth. It was a case of the massive fetomaternal hemorrhage of more than 300 mL.

Keywords: Fetomaternal transfusion, Anemia, Newborn baby

References

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Fig. 1.
The baby shows pale skin color on whole body at birth.
pn-30-40f1.tif
Fig. 2.
The infantogram shows normal cardiac size and shape, also shows intubation tube, umbilical artery and vein catheter inserted state.
pn-30-40f2.tif
Fig. 3.
The amplitude integrates electroencephalography shows continuous low voltage pattern (lower margin is continuously and without much variability at or below 5 µV and upper margin does not exceed 10 µV) and mimic seizure activity (artifact) due to handling (arrows).
pn-30-40f3.tif
Table 1.
Clinical Characteristics of Mothers with Massive Fetomaternal Hemorrhage
Case Age (years) Parity Type of delivery Risk factor∗ Hemoglobulin (g/d dL) pre/post delivery Fetal distress
Kim et al.15              
1 27 0–0–0–0 Twin C/S – 11.1 10.9 DFBM, LD
2 31 0–0–1–0 C/S – 11.0 10.3 LD
3 29 0–0–0–0 C/S – 11.7 10.6 –
4 30 0–0–0–0 C/S – 10.4 – DFBM, LD
5 30 0–0–0–0 NFSD – 11 8.9 LD
Lee et al.16              
6 ? ? NFSD – – 5.1 ?
7 31 0–0–1–0 C/S – – 3.1 ?
Marciano et al. .17            
8 30 0–0–0–0 C/S – – 2.8 LD
9 ? ? C/S –   7.5 LD
10 ? 0–0–0–0 C/S – – 3.8 –
11 35 0–0–0–0 NFSD – – 9.3 –
12 28 2–0–1–2 C/S – – 8.5 –

Abbreviations: C/S, ceasarian section; DFBM, decreased fetal body movement; LD, late deceleration; NFSD, normal fullterm spontaneous delivery. ∗Antepatum death, abdominal trauma, placental malformation (choriocarcinoma, chorioangioma), amniocentesis, placenta previa, abruptio placenta.

Table 2.
Clinical Characteristics of Neonates with Massive Fetomaternal Hemorrhage
Case∗/sex Gestationa age (weeks l Weight s) (g) ( Apgar score 1, 5 minutes) Clinical manifestation Hb (g/dL) K-B test (%) Associated diseases Transfusio (15 mL/kg n† Prognosis g)
Kim et al.15                  
1/M 33 1,880 1,1 Pale, RD, HS 4.2 20 RDS 6 Normal
1'/M 33 1,790 1,1 Pale, RD, HS 3.7 20 RDS 6 Normal
2/F 39 3,160 5,9 Pale, HS 4.4 15 Pure red cell anemia 2 Pure red cell anemia
3/M 41 3,220 6,9 Pale, HS 4.7 13 – 2 Normal
4/F 35 2,460 4,7 Pale, HS 5.5 8 RDS 4 Normal
5/F 41 3,250 7,10 Pale 8.8 9.2 – 2 Normal
Lee et al.16                  
6/F 40 3,600 ? Pale, RD, HS 5.1 6.1 (HPLC) M Metabolic acidosis, Pneumothorax 2 Normal
7/F 36 2,870 6,7 Pale, RD, HS 3.1 6.5 (HPLC) Metabolic acidosis 2 Normal
Marciano et a al.17                
8/F 39 3,225 7,8 Pale, RD, HS 2.8 ? Metabolic acidosis,    
Hypoglycem ia 2 Normal              
9/F 37 2,080 7,8 Pale, RD 7.5 ? Respiratory acidosis 2 Normal
10/M 39 3,320 8,9 Pale, RD, HS 3.8 ? PPHN ? Normal
11/M 37 2,800 1,5 Pale, RD, HS 9.3 ? Metabolic acidosis 1 Normal
12/M 37 2,800 9,10 Pale 8.5 ? – 1 Normal

Abbreviations: Hb, hemoglobin; K-B test, Kleihauer-Betke test; M, male; RD, respiratory distress; HS, hypovolemic shock; RDS, respiratory distress syndrome; F, female; HPLC high performance liquid chromatography; PPHN, persistent pulmonary hypertension of the newborn. ∗Number was matched with maternal cases & newborn cases.

† Number of transfusion.

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