Spontane massieve foetomaternale transfusie: casusbespreking met literatuuroverzicht

Abstract

Spontaneous massive fetomaternal transfusion: case report and review of the literature Fetomaternal hemorrhage (FMT) occurs when fetal blood enters the maternal circulation, often due to childbirth, trauma, placental injury or medical procedures. Although FMT is relatively common, spontaneous massive FMT is rare and potentially fatal. This arises from the abrupt rupture of fetal vessels, leading to severe bleeding into the maternal circulation. The diagnosis is challenging and delayed recognition may result in severe fetal and maternal complications. A patient presented with a history of completely absent fetal movements without identifiable cause. Based on an abnormal cardiotocogram (CTG) and an ultrasound showing an increased peak systolic velocity in the middle cerebral artery (PSV-MCA), the diagnosis of spontaneous massive FMT was made. Following an emergency cesarean section, a vital but anemic neonate was born. Spontaneous massive FMT is difficult to diagnose due to its variable symptoms, e.g. fetal tachycardia, absent fetal movements and asphyxia. Conventional diagnostic tools such as the history taking, a CTG and an ultrasound have their value but also limitations. An increased PSV-MCA is an important ultrasound feature for diagnosing fetal anemia. Fetal cells in the maternal circulation provide the prescribed diagnosis. Its treatment includes an intrauterine transfusion (IUT) or a cesarean section, depending on the gestational age and the FMT development. This case report and literature review emphasize the importance of FMT awareness among pregnant women. In case of reduced fetal movements, a CTG and a transabdominal ultrasound should always be performed, with PSV-MCA measurement to confirm or exclude fetal anemia.