Occult Fetomaternal Haemorrhage As a Cause of Fetal Mortality and Morbidity

Spontaneous fetomaternal haemorrhage is an important, but usually overlooked, cause of perinatal mortality and morbidity. Although fetomaternal bleeding in the third trimester of pregnancy is common it is normally less than 0.1 ml. A fetal macrotransfusion (greater than 5 ml) is uncommon, but is important because it is insidious, unexpected and usually occurs in completely normal pregnancies. This paper analyses the perinatal mortality and morbidity associated with occult fetomaternal haemorrhage at the Royal Women's Hospital, Melbourne. It may lead to fetal distress before and during labour, unexplained stillbirth, or nonhaemolytic neonatal anaemia. A Kleihauer test on maternal blood will readily detect fetomaternal bleeding, and we describe a simple way of calculating the absolute volume of fetal red cells present. Greater awareness of the problem may eventually lead to diagnosis sufficiently early to permit effective treatment.     

Pseudosinusoidal Fetal Heart Rate Pattern and Fetal Anaemia: Case Report and Review

Summary: The association of a pseudosinusoidal fetal heart rate pattern with fetal anaemia is reported. A system of classifying this cardiotocographic feature as minor, intermediate or major is discussed. The clinical correlates of each of these gradings and the differentiation from a true sinusoidal fetal heart rate pattern are presented.     

A Case Report of Decreased Fetal Movement During Fetomaternal Hemorrhage

Fetomaternal hemorrhage is a rare, potentially catastrophic event for a fetus. Leakage of the fetus’s blood into the mother’s circulation can cause fetal anemia, hydrops, and even death. The prevailing symptom is decreased fetal movement, and signs can include a sinusoidal electronic fetal monitor pattern, a positive Kleihauer-Betke test, or changes in fetal Doppler blood flow. A mother’s report or perception of decreased fetal movement coupled with a nonreactive nonstress test or abnormal ultrasound findings should prompt an investigation into underlying causes.     

Antenatal Fetal Heart Rate Monitoring

Summary: The value of antenatal fetal heart rate monitoring has been studied in 110 patients. When the fetal heart rate pattern was normal, the fetal outcome was satisfactory. When abnormalities of the fetal heart rate were present there was an increased incidence of fetal distress in labour, and reduced Apgar scores at 1 and 5 minutes. The place of fetal heart rate monitoring in antenatal care is discussed.     

Sinusoidal Antenatal Fetal Heart Rate Patterns

The sinusoidal fetal heart rate pattern is significantly associated with severe fetal anaemia when seen in the antenatal period. Strict adherence to definition is important, as pseudosinusoidal patterns do not have the same grave prognostic significance. If this fetal heart rate pattern is seen antenatally it is our contention that the baby should be delivered urgently by Caesarean section, unless the fetal anaemia can be treated in utero.     

Electronic Fetal Heart Rate Monitoring with Intrauterine Fetal Demise

Management of patients during labor is often based upon interpretation of electronic fetal heart rate tracings. Misdiagnoses of these records can lead to inappropriate actions, including cesarean delivery for presumed fetal distress. This case study, using a heart rate tracing from a patient with intrauterine fetal death, describes the findings, reviews the origin of the electronic signal, and outlines the means to distinguish the fetal and maternal cardiac impulses.     

Intermittent Sinusoidal Fetal Heart Rate and Massive Maternal-Fetal Hemorrhage: A Case Report

BackgroundA sinusoidal fetal heart rate pattern is a well-documented sign of maternal-fetal hemorrhage; however, an intermittent sinusoidal pattern is rare.CaseThis is a case of a 26-year-old primigravida who presented with decreased fetal movement. On fetal heart rate monitoring there were episodes of intermittent sinusoidal fetal heart rate pattern, and the baby was born with anemia.ConclusionThis case highlights the need for increased vigilance and consideration of a diagnosis of maternal-fetal hemorrhage when an intermittent sinusoidal fetal heart rate pattern is identified.     

Telephone Fetal Heart Rate Monitoring in South Australia

A pilot trial was conducted to assess the technical feasibility of long range fetal heart monitoring by telephone in an Australian setting. The indications for such monitoring and patient ability and attitude towards self-monitoring was also assessed. One hundred and fifty seven tracings were received from 57 women using a simple doppler device to transmit fetal heart sounds to the central hospital fetal monitor. Thirty three of the patients were in country hospitals and 24 were at home. Gestation ranged from 26 to 42 weeks' gestation. Eighty six percent of the country hospital tracings and 94% of the home tracings were easily interpretable. The large majority of tracings were normal and appeared to encourage conservative management by the attendants. Two tracings were abnormal and these influenced early delivery in both cases. Nearly all women using the monitor at home found the procedure easy and reassuring. Tracings from country hospitals were initiated usually after an acute antenatal complication, whereas the indications for home-monitoring were prompted by longer-term, medium-risk factors. Home-monitoring may reduce the inconvenience and expense of inpatient or outpatient care and country hospitals without electronic fetal monitors may benefit from such a service. The selection of patients who might benefit from such technology remains controversial and warrants a prospective randomized controlled trial.     

Epidural Analgesia and Fetal Heart Rate Abnormalities

Summary: Lumbar epidural analgesia is frequently associated with fetal heart rate abnormalities. Fluid preloading prior to the procedure significantly reduces the incidence of abnormal fetal heart rate patterns (p = 0.02). The mechanisms of these changes are discussed and the importance of maternal hypotension is evaluated. Fluid preloading and continuous electronic fetal monitoring should be considered routine for all women undergoing this procedure.     

Vibroacoustic Stimulation and Fetal Heart Rate in Nonstress Tests

Two methods of vibroacoustic stimulation were compared with traditional nonstress tests. Fetal heart rate tracings following stimulation had more accelerations and were of greater amplitude and duration than in the control group. The length of time required to obtain a reactive nonstress test was almost 15 minutes shorter when vibroacoustic stimulation was applied than when vibroacoustic stimulation was not used. Vibroacoustic stimulation elicited a heightened reactivity that persisted beyond the observation period in 30 of 45 (67%) of the experimental group subjects.