Fetomaternal macrotransfusion – A case series

Ziel: Already at the beginning of the last century, it was hypothesized that fetal cells might pass into maternal circulation (Dienst A, 1905). In most cases, the passing volume is small, being < 15ml (Sebring et al, 1990). Fetomaternal macrotransfusion, which may lead to life-threatening blood loss, means a transfer of more than 150ml or 50% of the total fetal blood volume. Risk factors include caesarean sections, multiple gestations, abruptions, placental retention, and abdominal version or trauma. Our aim was to retrospectively analyse cases of massive fetomaternal transfusion between XII/2004 and II/2010.

Methodik: Four cases of fetomaternal macrotransfusion are presented. We analysed maternal age, gestational age, risk factors, symptoms, diagnostic procedures, and perinatal outcome.

Ergebnis: The mothers were 26–39 years of age. All carried singletons (3 boys, 1 girl). One woman had 3 abruptions; there were no further risk factors. Three women realized reduced fetal movements. CTG showed sinusoidal variability in three cases and absent variability with sinusoidal tendency in one case. The peak systolic velocity in the mid cerebral artery was increased in two cases, leading to rescue caesarean sections. Stillbirth occurred in one case; the other three children needed emergency packed red blood cells (PRC) and ventilatory assistance and had no paediatric or neurological abnormalities at discharge. Kleihaur-Betke tests revealed massive fetomaternal hemorrhage, with fetal haemoglobin being 4.1, 5, 5.8, and 7.9%, respectively.

Schlussfolgerung: The incidence of fetomaternal macrotransfusion has been estimated to be 0.04% (Laube et al., 1982), but may be underreported (Wylie et al., 2010). As fetal consequences may be devastating, it is urgent to be aware of it. This case series underlines the importance of advising pregnant women to seek immediate medical advice if they note reduced frequency and abnormal patterns of fetal movements. If possible, they should attend a clinic where PRC transfusion is possible.

Literatur: Dienst A. Zentralbl Gynakol 1905;29:353. Laube DW, Schauberger CW. Fetomaternal bleeding as a cause for "unexplained" fetal death. Obstet Gynecol 1982;60:649-51. Sebring ES, Polesky HF. Fetomaternal hemorrhage: incidence, risk factors, time of occurrence, and clinical effects. Transfusion 1990;30:344-57. Wylie BJ, D’Alton ME. Fetomaternal hemorrhage. Obstet Gynecol 2010;115:1039-51.

FMTS - fetomaternal macrotransfusion - hemorrhage - rescue caesarean - stillbirth