[Maternal-fetal hemorrhagia: Description of 103 cases and analysis of predictive factors of neonatal outcome].

OBJECTIVES

Maternal-fetal haemorrhage (MFH) can be responsible for anaemia and hypovolaemic shock with a life-threatening foetal/neonatal outcome. In FMH, the indications for the Kleihauer-Betke test (TKB), paraclinical monitoring and obstetric management are not standardised. The aim was to analyse the diagnostic circumstances and neonatal outcomes in cases of FMH.

METHODS

Retrospective cohort including all patients with a positive TKB performed at the EFS center between 2012 and 2020 (22,715 Tests) for two type 3 maternities after exclusion of tests to prevent rhesus immunisation. Adverse neonatal outcome was defined by a composite criterion. The volume of FMH was expressed as the volume of blood transfused relative to the estimated foetal weight or neonatal weight.

RESULTS

Among the 103 patients included, the reason for performing TKB was a decrease in active foetal movements (49.5%). FMH was <10mL/kg in 45.6% of cases and >30mL/kg (massive FMH) in 33%. In the massive FMH group there were 12 in utero deaths, and in the live foetuses, the Manning ultrasound score was normal (8/8) in 68.4% of cases, brain velocities <1.5MoM in 26.7% and normal FHR in 22.7% of cases. All live-born infants in this group survived, 78.3% were transfused and two developed neurological sequelae. The ratio of FMH volume to fetal weight was the best predictor of postnatal transfusion in the first week of life.

CONCLUSIONS

Decreased perception of fetal movements was the main reason for looking for FMH. Ultrasound-Doppler and FHR could be normal in massive FMH, even in cases of decreased perception of fetal movements.