Graham E M, Freedman L J, Forouzan I, Morgan M A
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, USA.
South Med J. 1996 Sep;89(9):911-4. doi: 10.1097/00007611-199609000-00014.
Massive fetomaternal hemorrhage has been associated with numerous risk factors and can occur spontaneously. The risk is probably greater when a woman who is Rh negative has an ABO-compatible fetus. We report the case of a gravid, A-negative unsensitized patient who came to the hospital at term complaining of decreased fetal movement over the previous 24 hours. During evaluation, the fetal heart rate was found to have decreased beat-to-beat variability and repetitive late decelerations, and the mother was delivered of a 3,005 gA-positive neonate (by cesarean section) with a hemoglobin level of 2.9 g/dL. An acid elution test showed 400 mL of fetal blood in the maternal circulation, and the patient received 23 ampules (6,900 micrograms) of Rh immune globulin postpartum. The patient's condition was observed for 156 days after delivery; she did not become sensitized to the Rh factor. A massive fetomaternal hemorrhage can occur without any antecedent risk factors, with a risk of subsequent morbidity to the neonate. Sensitization can be prevented by prompt administration of adequate amounts of Rh immune globulin.
大量胎儿-母体出血与多种危险因素相关，且可自发发生。当Rh阴性的女性怀有ABO血型相容的胎儿时，风险可能更高。我们报告一例妊娠晚期、A阴性、未致敏的患者，她在足月时因前24小时胎动减少前来医院就诊。在评估过程中，发现胎儿心率逐搏变异减少且有反复晚期减速，随后（通过剖宫产）娩出一名体重3005g的A阳性新生儿，其血红蛋白水平为2.9g/dL。酸洗脱试验显示母体循环中有400mL胎儿血，患者产后接受了23支（6900微克）Rh免疫球蛋白。产后对患者的情况观察了156天；她未对Rh因子致敏。大量胎儿-母体出血可在无任何既往危险因素的情况下发生，会给新生儿带来后续发病风险。及时给予足量的Rh免疫球蛋白可预防致敏。
