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Fetal-maternal haemorrhage

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Fetal-maternal haemorrhage
SpecialtyHematology Edit this on Wikidata

Feto-maternal haemorrhage may be defined as the loss of fetal blood cells into the maternal circulation. It takes place in normal pregnancies as well as when there are obstetric or trauma related complications to pregnancy.

Normally the maternal circulation and the fetal circulation are kept from direct contact with each other, with gas and nutrient exchange taking place across a membrane in the placenta made of two layers, the syncytiotrophoblast and the cytotrophoblast. Feto-maternal haemorrhage occurs when this membrane ceases to function as a barrier and fetal cells may come in contact with and enter the maternal vessels in the decidua/endometrium.

Description

Normal Pregnancy

It is estimated that less than 1mL of fetal blood is lost to the maternal circulation during normal labour in around 96% of normal deliveries.[1][2] The loss of this small amount of blood may however be a sensitising event and stimluate antibody production to the fetal red blood cells, and example of which is Rhesus disease of the newborn.

Abnormal Pregnancy

Causes of increased feto-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found.

Up to 30mL of feto-maternal transfusion may take place with no significant signs or symptoms seen in either mother or fetus.[3] Loss in excess of this may result in significant morbidity and mortality to the fetus. Feto-maternal haemorrhage is one cause of intrauterine death (IUD).

Treatment

If ongoing and rapid haemorrhage is occurring then immediate delivery of the fetus may be indicated if the fetus is sufficiently developed.[4] If the haemorrhage has already occurred and now stopped, an inutero transfusion of red cells to the fetus may be recommended.[5]

References

  1. ^ Sebring ES, Polesky HF. Fetomaternal Hemorrhage: Incidence, risk factors, time of occurrence, and clinical effects. Transfusion 1990; 30:344-357.
  2. ^ Medearis AL, Hensleigh Pa, Parks DR, Herzenberh LA. Detection of fetal erythrocytes in maternal blood post partum with the fluorescence-activated cell sorter. American Journal of Obstetrics and Gynaecology 1984; 48:290-295.
  3. ^ Polesky HF Sebring ES. Evaluation of methods of detection and quantitation of fetal cells and their effects on Rh Ig usage. American Journal of Clinical Pathology 198 1; 76(suppl):525-529.
  4. ^ Massive fetomaternal hemorrhage and oxytocin contraction test: case report and review Arch Gynecol Obstet. 2004 Jan ;269 (2):149-51 14648183 (P,S,G,E,B)
  5. ^ Massive fetomaternal hemorrhage and oxytocin contraction test: case report and review Arch Gynecol Obstet. 2004 Jan ;269 (2):149-51 14648183 (P,S,G,E,B)
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