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Fetomaternal hemorrhage complicated pregnancy

risks, identification, and management

Stefanovic, Vedran

Current Opinion in Obstetrics and Gynecology: April 2016 - Volume 28 - Issue 2 - p 86–94
doi: 10.1097/GCO.0000000000000248
MATERNAL FETAL MEDICINE: Edited by James F. Smith Jr.

Purpose of review This article aims not only to review recent literature about the clinical features of massive fetomaternal hemorrhage (FMH) and identification of risk factors, but also to alert obstetricians and pediatricians to this underdiagnosed and underestimated severe obstetrical issue. In addition, a simplified flow chart for the antenatal management of suspected FMH is proposed.

Recent findings Improvements in obstetrical and neonatal care have decreased perinatal morbidity and mortality and the rate of stillbirth. Unfortunately, because of the nonspecific signs on presentation, adverse outcome associated with massive FMH has not followed this trend and still has devastating consequences. As even the definition varies among publications and there is lack of universal screening, the real nature still remains obscure. Improvements in the diagnosis of fetal anemia, laboratory and intrauterine transfusion techniques, and the implementation of prenatal and postnatal neuroprotection give some hope for the better outcome in the most severe cases. Unfortunately, obstetricians’ awareness of the massive FMH remains still at an unacceptably low level.

Summary There is an urgent need for the internationally accepted definition, standardized pregnancy management protocol, and structured follow-up of neonates from such pregnancies. We suggest the international registry of massive FMH cases.

Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

Correspondence to A/Professor Vedran Stefanovic, Helsinki University Central Hospital, Helsinki, Finland. Tel: +358 50 427 1230; e-mail:

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