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      Hemorragia fetomaterna masiva como causa de hidrops en gestación a término: Reporte de caso y revisión de la literatura Translated title: Massive fetomaternal hemorrage cause hydrops in pregnancy at term: Case report and literature revision

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          Abstract

          Objetivo: la hemorragia fetomaterna masiva es una complicación rara del embarazo, que puede causar anemia fetal severa y muerte fetal intrauterina. Se presenta un caso clínico con el objetivo de hacer una revisión de la fisiopatología del diagnóstico y del tratamiento Materiales y métodos: se presenta el caso clínico de una mujer en la semana 39 de embarazo, remitida al Hospital La Paz de Madrid, centro de referencia de atención materna y perinatal, por signos ecográficos de hidrops y de insuficiencia cardíaca derecha. El registro cardiotocográfico evidenció un patrón sinusoidal. La recién nacida presentó acidosis metabólica y anemia severa. El estudio anatomopatológico de la placenta fue sugestivo de anemia fetal crónica. El test de Kleihauer-Betke evidenció hemorragia fetomaterna de 90-100 ml. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía Pubmed, EMBASE, LILACS y SciELO y la biblioteca Cochrane. Conclusión: el diagnóstico intrauterino es difícil, se debe sospechar cuando una mujer refiere reducción de movimientos fetales y cuando el registro cardiotocográfico muestra un patrón sinusoidal. En general, el estudio ecográfico es anodino, el Doppler de la arteria cerebral media puede ayudar en la identificación de los casos de anemia fetal, donde se evidencia un aumento del pico sistólico. Es importante la identificación precoz de los casos afectados para empezar un tratamiento sintomático de la anemia.

          Translated abstract

          Objective: massive fetomaternal hemorrhage is a rarely occurring complication during pregnancy which can cause severe fetal anemia and intrauterine fetal death. A clinical case is presented here to review the pertinent pathophysiology, diagnosis and treatment. Materials and methods: the case of a 39 weeks pregnant woman admitted to La Paz Hospital in Madrid is reported; this hospital is the center for perinatal and maternal attention. The patient was referred due to sonographic signs of hydrops and right heart failure. Cardiotocographic records showed a sinusoidal pattern. The newborn presented metabolic acidosis and severe anemia. Pathologic examination of the placenta was suggestive of chronic fetal anemia. The Kleihauer-Betke test revealed a 90-100 ml fetomaternal hemorrhage. A literature search was made in Medline via Pubmed, EMBASE, LILACS and SciELO and the Cochrane Library. Conclusion: intrauterine diagnosis is difficult; massive fetomaternal hemorrhage should be suspected when a woman refers to reduced fetal movements and when the record shows a sinusoidal pattern in cardiotocography. Ultrasound is usually bland and Doppler of the middle cerebral artery may help in identifying cases of fetal anemia, revealing an increased systolic peak. Such cases must be identified early on to start symptomatic treatment of anemia.

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          Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop.

          Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death. The optimal classification system would identify the pathophysiologic entity initiating the chain of events that irreversibly led to death. Because the integrity of the classification is based on available pathologic, clinical, and diagnostic data, experts emphasized that a complete stillbirth workup should be performed. Experts developed evidence-based characteristics of maternal, fetal, and placental conditions to attribute a condition as a cause of stillbirth. These conditions include infection, maternal medical conditions, antiphospholipid syndrome, heritable thrombophilias, red cell alloimmunization, platelet alloimmunization, congenital malformations, chromosomal abnormalities including confined placental mosaicism, fetomaternal hemorrhage, placental and umbilical cord abnormalities including vasa previa and placental abruption, complications of multifetal gestation, and uterine complications. In all cases, owing to lack of sufficient knowledge about disease states and normal development, there will be a degree of uncertainty regarding whether a specific condition was indeed the cause of death.
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            Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

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              Long-term prognosis for infants after massive fetomaternal hemorrhage.

              To evaluate the fetal, neonatal, and long-term prognosis of massive fetomaternal hemorrhage (20 mL or more). This series includes all patients with Kleihauer test values of 40 per 10,000 or higher over an 8-year period at two university hospitals. We examined obstetric, neonatal, and subsequent outcome data for the children. During the study period, 48 patients had massive fetomaternal hemorrhage (crude incidence 1.1 per 1,000; corrected incidence for Rh-negative women 4.6 per 1,000). Six fetal deaths were observed, representing 1.6% of all fetal deaths during the period. Nine newborns (18.7%) were transferred to neonatal intensive care unit (NICU) and five (10.4%) had transfusions. Fetomaternal hemorrhages of 20 mL/kg or more significantly increased the risk of fetal death, induced preterm delivery, transfer to NICU, and neonatal anemia requiring transfusion. Long-term follow-up was not associated with neurological sequelae (0%, 95% confidence interval 0.0-11.6%). When the transfused volume equals or exceeds 20 mL/kg, massive fetomaternal hemorrhage may lead to severe prenatal or neonatal complications. III.
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                Author and article information

                Journal
                rcog
                Revista Colombiana de Obstetricia y Ginecología
                Rev Colomb Obstet Ginecol
                Federación Colombiana de Obstetricia y Ginecología; Revista Colombiana de Obstetricia y Ginecología (Bogotá, Cundinamarca, Colombia )
                0034-7434
                2463-0225
                December 2011
                : 62
                : 4
                : 338-344
                Affiliations
                [03] Madrid orgnameHospital Universitario La Paz orgdiv1Departamento de Ginecología y Obstetricia orgdiv2Jefatura del Servicio España
                [02] Madrid orgnameHospital Universitario La Paz orgdiv1Departamento de Ginecología y Obstetricia España
                [01] Madrid orgnameHospital Universitario La Paz orgdiv1Departamento de Ginecología y Obstetricia España
                Article
                S0034-74342011000400008 S0034-7434(11)06200408
                0c8a1552-2c79-4c84-b42c-22f56cc7a130

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 7
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                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Reporte de Caso

                fetal anemia,hemorragia fetomaterna,patrón sinusoidal,test de Kleihauer-Betke,hidrops,anemia fetal,fetomaternal hemorrhage,sinusoidal pattern,Kleihauer-Betke test,hydrops

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