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Obstetrics & Gynecology 2007;110:256-260
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Long-Term Prognosis for Infants After Massive Fetomaternal Hemorrhage

Chrystèle Rubod, MD1, Philippe Deruelle, PhD1, Françoise Le Goueff, MD2, Virginie Tunez, MD3, Martine Fournier, MD4 and Damien Subtil, PhD1

From 1Hôpital Jeanne de Flandre, Université Lille II, France; 2Maternité Paul Gellé, Roubaix, France; 3Etablissement Français du Sang, Lille, France; and 4Laboratoire d’hématologie, Université Lille II, France.

OBJECTIVE: To evaluate the fetal, neonatal, and long-term prognosis of massive fetomaternal hemorrhage (20 mL or more).

METHODS: This series includes all patients with Kleihauer test values of 40 per 10,000 or higher over an 8-year period at two university hospitals. We examined obstetric, neonatal, and subsequent outcome data for the children.

RESULTS: During the study period, 48 patients had massive fetomaternal hemorrhage (crude incidence 1.1 per 1,000; corrected incidence for Rh-negative women 4.6 per 1,000). Six fetal deaths were observed, representing 1.6% of all fetal deaths during the period. Nine newborns (18.7%) were transferred to neonatal intensive care unit (NICU) and five (10.4%) had transfusions. Fetomaternal hemorrhages of 20 mL/kg or more significantly increased the risk of fetal death, induced preterm delivery, transfer to NICU, and neonatal anemia requiring transfusion. Long-term follow-up was not associated with neurological sequelae (0%, 95% confidence interval 0.0–11.6%).

CONCLUSION: When the transfused volume equals or exceeds 20 mL/kg, massive fetomaternal hemorrhage may lead to severe prenatal or neonatal complications.

LEVEL OF EVIDENCE: III






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