A case report and literature review recently published in the Journal of Biosciences and Medicine offers recommendations for the management of fetal maternal hemorrhage (FMH), a potential cause of fetal and neonatal alloimmune thrombocytopenia (FNAIT).
FMH occurs when red blood cells from the fetus cross through the placenta into the maternal circulation, leading to severe fetal blood loss. In some cases, FMH may trigger FNAIT when the mother’s immune system recognizes proteins found on the fetal platelets as foreign.
“At present, clinical understanding of this disease is still limited, especially in primary hospitals where there may have been no exposure to FMH cases,” the authors wrote. Diagnosis of of FMH is often missed or delayed, posing significant risks to the fetus.
The case report describes a 31-year old pregnant woman who refused hospitalization at 37 weeks gestation after the fetal heart rate did not respond to external stimuli.
Read more about FNAIT causes and risk factors
The patient’s water broke at 39 weeks. Upon admission to the hospital, the fetal heart rate remained irregular, and immediate cesarean section was recommended. However, the patient repeatedly refused the procedure.
Although an emergency cesarean section was ultimately agreed upon, the optimal surgical window was missed, resulting in stillbirth.
In addition to the case report, the authors performed a literature review to develop a set of guidelines for diagnosing and managing FMH.
Reduced fetal movement, swelling and abnormal fetal heart rates are all potential signs of FMH that may require close monitoring and follow up, they emphasized. A variety of laboratory tests may also be performed to confirm a diagnosis of FMH.
Treatment for FMH should be tailored to the unique circumstances of the patient, the authors wrote. This may include intrauterine blood transfusion, particularly for pregnancies with a gestational age less than 32 weeks.
“In clinical practice, pregnant women should be cautious of the occurrence of fetal movement reduction, abnormal fetal heart monitoring, and pale skin in newborns during delivery, considering the possibility of FMH,” the study concluded.
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