Intrapartum Haemorrhage due to Idiopathic Rupture of the Fetal Placental Artery

EDITORIAL COMMENT: We accepted this interesting case report to remind readers that cardiotocography may identify fetal distress and the need for immediate delivery in women with intrapartum haemorrhage, which in this case resulted from fetal haemorrhage. May we also remind readers that a fetal origin should be considered in all cases of intrapartum blood loss since an abnormal cardiotocograph can be a late (too late!) sign from a fetus bleeding to death. Since fetal haemoglobin is resistant to alkali denaturation, a sample of blood from the vagina, diluted in water, will remain pink on the addition of 10% sodium hydroxide if fetal in origin, whereas it will turn brown if maternal (Apt test). A bottle of 10% sodium hydroxide should be available in every delivery suite so that this test can be performed when indicated; this is very often since how else can an 'excessive show' be distinguished from haemorrhage from a vasa praevia? The solution has a shelf-life of only 1 month; a time-expired solution may fail to turn maternal blood brown and thus give a false positive test for fetal blood.