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Case Reports in Obstetrics and Gynecology
Volume 2014, Article ID 296463, 4 pages
http://dx.doi.org/10.1155/2014/296463
Case Report

Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri School of Medicine, Kansas City, MO 64108, USA
2Division of Pediatric Cardiology, Department of Pediatrics, University of Missouri School of Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA

Received 30 November 2013; Accepted 20 February 2014; Published 7 April 2014

Academic Editors: S. Rasmussen and S. Salhan

Copyright © 2014 Paul Singh and Tara Swanson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management. Case. A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate’s initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage. Discussion. One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed.