Massive Fetomaternal Hemorrhage and Severe Anemia in the Newborn – Two Case Reports

Introduction

Fetomaternal hemorrhage (FMH) is defined as the entrance of fetal erythrocytes into the maternal circulation. In late gestation, it occurs in 40 – 50 % of all pregnancies. In 98 % of the cases the amount of bleeding is less than 0.1 mL. Massive FMH is defined as a loss of more than 150 mL or approximately 50 % of the fetal blood volume. It occurs in one out of 1000 deliveries (Akanli LF et al. Am J Perinatol 1997; 14: 271 – 273). The most common symptoms are anemia, decreased or absent fetal body movement, and unexpected stillbirth (Giacoia GP. Obstet Gynecol Surv 1997; 52: 372 – 380). Specific symptoms do not exist. In most cases, the cause for massive FMH remains unknown. The extent of FMH can be measured with the Kleihauer-Betke stain.

We report two cases of massive FMH with decreased fetal body movement. Both newborns were severely anemic and required intensive support after delivery.