Case Analysis of Fetal-Maternal Transfusion Syndrome

Fetal maternal transfusion syndrome is generally caused by severe hemorrhage, edema, anemia, and organ failure in the womb. Most of these symptoms may result in death if rescue efforts are ineffective. If the child is found to have many physical illnesses after birth, how should we deal with this disease?

Fetomaternal hemorrhage syndrome (FMH) refers to a group of syndromes in which fetal blood enters the maternal blood circulation from the intervillous space of the placenta due to some reasons, resulting in varying degrees of fetal blood loss or maternal hemolytic transfusion reaction. It is extremely rare. Large amounts of fetomaternal blood transfusion can cause fetal anemia and developmental obstruction. In severe cases, it can cause fetal intrauterine death, neonatal anemia, shock, and death. The perinatal mortality rate is as high as 33% to 50%. In the past two years, our hospital has discovered two cases of severe fetomaternal transfusion syndrome, which are reported as follows.

Case 1, patient was 33 years old, was admitted to the hospital on November 5, 2007, was pregnant with 2 babies and had 1 baby. She had 9 regular prenatal checkups during pregnancy, and no obvious abnormalities were found. At 37+3 weeks of pregnancy, the patient presented to our hospital with decreased fetal movement for 1 day. Fetal heart rate monitoring (GE-170 series) performed in the outpatient clinic showed no acceleration response during the 20-min non-stress test (NST), with one deceleration, and the fetal heart rate was 60-80 beats/min, which lasted for about 4 minutes before improving. The patient was admitted to the hospital and given 10% glucose solution plus 3.0 g of vitamin C for fluid replacement. At the same time, the fetal heart rate monitoring was repeated, which showed that there was no acceleration reaction in the NST, and one section was like a sine curve, which lasted for about 15 minutes (see Figure 1). Considering fetal distress, a cesarean section was performed. During the operation, the amniotic fluid was clear and a baby boy weighing 2955 g was delivered. His crying, breathing, reaction, heart rate and muscle tone were all normal, but his skin and mucous membranes were extremely pale, with a 1-min Apgar score of 8. The operation went smoothly and there were no abnormalities in the umbilical cord and placenta. The newborn's blood type is B, Rh(+). Routine blood test showed WBC 42.21×10 9/L, RBC 1.06×10 9/L, Hb 40 g/L, hematocrit 12.2%, and platelet 177×10 9/L. The mother's blood type was AB, Rh(+), and the blood routine test and thalassemia screening were normal. The newborn's blood oxygen saturation was around 70% to 85%, and he was in critical condition. He was transferred to a municipal specialist hospital and was discharged after one week of blood transfusion treatment. Immediately after birth, the maternal blood alpha-fetoprotein level was >300 U/L (Siemens IMM ULITE-100, chemiluminescence detection).

Case 2: The patient was 34 years old and was admitted to the hospital on May 7, 2008. She was gravida 1 and had a 0-partum period. She had 5 regular prenatal checkups during her pregnancy and nothing special was found. A pregnant woman at 37+3 weeks presented to our hospital because of decreased fetal movement for 2 days. Fetal heart rate monitoring was performed in the outpatient clinic. The NST showed no acceleration response when the fetus moved, and there was 1 variable deceleration, reaching 100 beats/min. The biophysical score (manning score) showed that the sum of the four indicators of fetal breathing movement, fetal movement, fetal muscle tension and amniotic fluid index was 8 points. Umbilical blood flow and middle cerebral artery index were normal (color Doppler ultrasound ALOKA SSD-α10). After admission, the patient was given oxygen, 10% glucose solution with 2 vials of energy and 3.0 g of vitamin C for 1 day. The fetal heart rate monitoring the next day showed that the NST had no acceleration reaction and presented a sinusoidal curve, which lasted for 40 minutes (see Figure 2). Considering fetal distress, a cesarean section was performed. The operation was successful and a baby girl was delivered. She weighed 2525 g and the Apgar score was 8 at 1 min.

In the above article, we learned about fetal-maternal transfusion syndrome, but this disease has a huge impact on people. It is even a very rare obstetric disease. The occurrence of this disease endangers the health of the mother and fetus and may even cause the death of the fetus.