Massive Fetomaternal Hemorrhage in an extreme Preterm Pregnancy: A Case Report and Review of the Literature.

Abstract

Fetomaternal hemorrhage (FMH) is a physiological phenomenon with passage of small volumes of fetal erythrocytes into the maternal circulation. A loss of >= 20 % of the fetal blood volume is defined as massive FMH and can result in severe pregnancy complications. Document risk factor for FMH include invasive diagnostic procedures, placental anomalies, external cephalic version, and abdominal trauma. We present a case illustrating these risks in the context of trauma during an extremely preterm pregnancy.

Case presentation: A gravida 2, para 1 woman at 26 + 2 weeks' gestation was involved in a motor vehicle collision resulting in seat-belt compression and airbag deployment. On admission, her initial assessment-including maternal history, physical examination-was unremarkable except for visible abdominal bruising. She was admitted for extended fetal monitoring. During admission, severe fetal distress developed, prompting an emergency caesarean section. Intraoperatively, there was no evidence of placental abruption or uterine trauma. The male neonate was profoundly pale at birth, consistent with profound hypovolemia and severe anemia. Despite resuscitative efforts and blood transfusion, spontaneous circulation ad respiration was not achieves and the neonate died shortly after birth. Maternal follow-up was uneventful, with no post-operative complications. A positive Kleihauer-Betke test confirmed the diagnosis massive FMH.

Conclusions: Trauma during pregnancy, while often minor, can lead to devastating complications such as massive FMH. The management of massive FMH in the context of extreme preterm pregnancies remains a clinical challenge, in the absence of evidence-based protocols and guidelines. Health care professionals should weigh the likelihood of neonatal survival against the benefits of an emergency delivery. Early recognition and treatment are essential, but outcomes may still be poor, emphasizing the need for ongoing research to improve maternal and fetal prognosis in such scenarios.