Massive feto-maternal haemorrhage: A case report

Feto-maternal haemorrhage (FMH) is the passage of fetal blood in to the maternal circulation during pregnancy or delivery. Aetiology is largely spontaneous with no cause but placental trauma is a known cause. Insignificant FMH may occur nearly in all pregnancies and there is no defined degree of fetal haemorrhage to define FMH. Most episodes involve very small quantities of blood but in some cases, the haemorrhage is acute and massive enough to compromise the fetus, resul-ting in fetal demise, stillbirth or severe neonatal anaemia causing circulatory shock or hydrops. Symptoms of a significant FMH can be subtle, non-specific and difficult to identify at onset. Diagnostic clues are anaemia at birth in an otherwise well baby with no or minimal jaundice. The most useful diagnostic tests are Kleihauer test on maternal blood to quantify fetal red cells in maternal circulation and blood film. This case is of a neonate born with severe pallor with a haemoglobin of 2.6 g/dL and no clinical or laboratory evidence of haemolysis. Kleihauer test revealed 10% fetal red cells in maternal blood accounting for 240 mL of FMH where approximately 90% of fetal blood has been transferred to maternal circulation. Baby was managed with blood transfusions and saved with minimal complications.