Eichbaum M, Gast A S, Sohn C
University of Heidelberg Medical School, Department of Gynecology and Obstetrics, Heidelberg, Germany.
Fetal Diagn Ther. 2006;21(4):334-8. doi: 10.1159/000092461.
Massive fetomaternal hemorrhage (FMH) is a rare complication in pregnancy that may cause hydrops or can even be life-threatening for the fetus. We report on the case of a 19-year-old gravida I, para 0, who presented to our clinic at 32 weeks of gestation due to decreased fetal movements. The initial fetal heart rate tracing at admission showed a sinusoidal pattern without decelerations. The ultrasound examination performed immediately described a normally developed fetus with normal amounts of amniotic fluid and without abnormities of the placental structure. Doppler sonography of the fetal middle cerebral artery gave rise to the strong suspicion of fetal anemia, so that a cordocentesis was prepared for potential intrauterine blood transfusion. Meanwhile, the rate of fetal hemoglobin (HbF) cells in the maternal blood was found to be markedly increased with 66 per thousand. Correspondingly, cardiotocographic findings worsened with repeated decelerations, thus an immediate cesarean section was performed based on the suspected diagnosis of an acute FMH. A fetus weighing 1,860 g was delivered, who had severe anemia with hemoglobin level of 4.0 g/dl. After a direct blood transfusion, HbF levels normalized rapidly, the fetus stabilized, and a normal recovery has thus far been reported. The presented case demonstrates the successful and straightforward diagnosis, as well as the management of a case of severe FMH and illustrates the special value of Doppler sonography in this context.
大量胎儿-母体出血（FMH）是妊娠期间一种罕见的并发症，可能导致胎儿水肿，甚至对胎儿有生命危险。我们报告一例19岁初产妇，孕0产0，因胎动减少于妊娠32周就诊于我院。入院时最初的胎儿心率监测显示正弦波图形，无减速。立即进行的超声检查显示胎儿发育正常，羊水适量，胎盘结构无异常。胎儿大脑中动脉的多普勒超声检查强烈怀疑胎儿贫血，因此准备进行脐静脉穿刺以便可能进行宫内输血。与此同时，发现母体血液中胎儿血红蛋白（HbF）细胞比例显著增加，为66‰。相应地，胎心监护结果因反复减速而恶化，因此基于急性FMH的疑似诊断立即进行了剖宫产。娩出一名体重1860g的胎儿，其患有严重贫血，血红蛋白水平为4.0g/dl。直接输血后，HbF水平迅速恢复正常，胎儿情况稳定，迄今已报告恢复正常。该病例展示了对一例严重FMH病例的成功且直接的诊断及处理，并说明了在此情况下多普勒超声检查的特殊价值。
