Massive fetomaternal hemorrhage in a monochorionic-diamniotic twin pregnancy: a case report

Abstract

Fetomaternal hemorrhage (FMH) result into severe, life-threatening fetal anemia and cause intrauterine death of the fetus. It is tough for an early diagnosis of FMH before pregnancy and few authors reported FMH in a twin pregnancy. Therefore, we reported a case of massive FMH. The patient felt a decrease in fetal movements at 33⁺⁵ gestational weeks. Cardiotocography showed sinusoidal heart rate patterns in one fetus. The fetal hemoglobin level in maternal blood was 6.4% (normal range for single pregnancy, 0.0%–2.0%). Since the patient was diagnosed with fetal distress, cesarean section was performed and both babies delivered to receive neonatal treatment. Severe anemia was apparent in both neonates, based on red blood cell count, hemoglobin concentration, and hematocrit of 0.75 × 10¹²/L and 0.61 × 10¹²/L, 2.8 g/dL and 2.4 g/dL, and 10.0% and 8.4%, respectively. The neonates were admitted to the intensive care unit for prematurity care and presently are well. In our experience, an early diagnosis of FMH contributed to saving fetus. Obstetricians should highlight fetal movements counting to every patient. Once massive FMH occurs in monochorionic twins, both fetuses may develop severe anemia and require emergency intervention.

Keywords:

• Fetomaternal hemorrhage
• monochorionic-diamniotic twin pregnancy
• sinusoidal heart rate patterns

Author contributions

Shuying Liao contributed to the protocol development, data collection, data analysis, and manuscript writing. Jitong Zhao contributed to protocol development and manuscript writing. Tao Li developed data analysis and manuscript editing. Tao Yi, Xiaojuan Lin, and Ce Bian involoved in manuscript editing. Chen Ling involved in protocol development, manuscript editing. All authors read and approved the final manuscript.

Ethics approval and consent to participate

This study was approved by the ethics committee on human research at West China Second Hospital, Sichuan University (No. 2019047). The patient provided informed consent for the publication of her clinical and imaging data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Sichuan Science and Technology Program [No. 2021YJ0011], Science and Technology Department of Chengdu, Key R&D Support Program [No. 2022-YF05-01551-SN], Medical Technology Project, Health Commission of Sichuan Province [No. 21PJ051], and Sichuan Province Science and Technology Support Program