Kosasa T S, Ebesugawa I, Nakayama R T, Hale R W
Department of Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine, Honolulu.
Obstet Gynecol. 1993 Oct;82(4 Pt 2 Suppl):711-4.
Massive fetomaternal hemorrhage occurs in one in 1000 deliveries and has been associated with decreased fetal movements and a sinusoidal fetal heart rate (FHR) pattern.
Three women presented with decreased fetal movements, nonreactive FHR patterns, and positive Kleihauer-Betke tests. All three were at a viable gestational age and were immediately delivered by cesarean. The three infants were severely anemic, with hemoglobin levels of 6.5, 5.3, and 5.1 g/dL, respectively.
A patient who presents with decreased fetal movement associated with a nonreactive FHR pattern and a positive Kleihauer-Betke test of more than 140 mL should be considered for immediate delivery if the gestational age is consistent with neonatal viability.
