Massive Fetomaternal Hemorrhage Unmasked By Flow Cytometry

Ranganatha Ashok Devaranavadagi, Nikitha Nekkileru, Netra Sangamesh Kannur, Hemanandini Jayaraman, Rajath Pejaver

Abstract

Fetomaternal hemorrhage (FMH), a rare but potentially life-threatening condition, occurs when fetal blood enters maternal circulation due to placental barrier disruption. It can lead to severe neonatal anemia, hypoxia, or even fetal demise, if undetected. Improving neonatal outcomes entirely depends on early identification and intervention.

We report the case of a 32-year-old primigravida who presented with decreased fetal movements for 2 hours, at a gestational age of 38 weeks. A sinusoidal pattern noted in the cardiotocogram (CTG), following which the woman was referred for emergency cesarean delivery. She delivered a female neonate weighing 2.52 kg. The neonate had an Apgar score of 7 at 1 minute and 8 at 5 minutes. The neonate was put on continuous positive airway pressure to manage respiratory distress and pallor. A complete blood count test revealed a hemoglobin level of 3.7 g/dL (indicative of anemia), with preserved marrow response. Flow cytometry confirmed massive FMH, with an estimated fetal blood loss of 109 mL (43 mL/kg). After packed red blood cell transfusions, the neonate showed rapid clinical improvement and was discharged in stable condition on day 4 of life.

Decreased fetal movements and the sinusoidal pattern on CTG serve as potential early clinical signs of FMH. This case demonstrates the importance of early diagnosis and prompt intervention in improving neonatal outcomes in FMH. Also, flow cytometry remains a diagnostic tool with a high sensitivity for confirming and quantifying FMH.