• Jadranka Domazet-Fink Zdravstveni dom Moste-Polje Enota Fužine Preglov trg NN 1000 Ljubljana
  • Maja Pestevšek Klinični oddelek za perinatologijo Ginekološka klinika Klinični center Šlajmerjeva 3 1525 Ljubljana
  • Živa Novak-Antolič Klinični oddelek za perinatologijo Ginekološka klinika Klinični center Šlajmerjeva 3 1525 Ljubljana
Keywords: fetal anaemia, cardiotocography, sinusoid pattern, Kleihauer-Betke test, silent CTG


Background. There are several different causes for fetomaternal haemorrhage. Sinusoidal pattern, which is relatively characteristic for fetal anaemia, may in its final stages completely disappear. Differential diagnosis of silent trace of cardiotocogram with late decelerations is quite difficult to solve.

Case report. A case of unusual injury of a pregnant woman is described. The injury led to fetomaternal haemorrhage. Typical sinusoidal pattern cardiotocogram was not seen and the differential diagnosis was hard to determine. Because of prompt intervention and efficient postnatal therapy the child and mother are both well. The dilemmas in regards to differential diagnosis are being discussed.

Conclusions. It is important to be very careful in history taking even if the situation is urgent. If there is no explanation for pathological cardiotocogram, decision must be made according to pregnant woman’s wishes. Kleihauer-Betke test, which is easy to perform and gives much information, is described.


Download data is not yet available.


Cuningham FG et al. Diseases and injuries of the fetus and newborn infant. 19th edition. Williams Obstetrics 1993; 44: 992–1023.

Manning FA. The alloimmune pregnancy. In: Manning FA ed. Fetal medicine principles and practice. Norwalk CT: Appleton & Lange, 1995: 395–449.

Simpson GE, Sun NH, Golbus MS. Changes in maternal serum alphafetoprotein levels associated with intrauterine genetic diagnostic procedures. Prenat Diagn 1984; 4: 207–11.

Bowman JM, Pollock JM. Transplacental fetal hemorrhage after amniocentesis. Obstet Gynecol 1985; 66: 749–54.

Stiller AG, Skafish PR. Placental chorioangioma: A rare cause of fetomaternal transfusion with maternal hemolysis and fetal distress. Obstet Gynecol 1986; 67: 296–8.

Brandt CA, Ryom C, Grove A. Chorioangioma placentae and feto-maternal transfusion; a report of two cases. Eur J Obstet Gynecol & Reprod Biol 1989; 33: 95–8.

Ollendorf DA, Goldberg JM, Abu-Jawdeh GM, Lurain JR. Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta. Obstet Gynecol 1991; 77: 329–30.

Novak-Antolič Ž. Rh-imunizacija. In: Pajntar M, Novak-Antolič Ž. Nosečnost in vodenje poroda. Ljubljana: Cankarjeva založba, 1994: 69–73.

Luyet F, Schmid J, Maroni E, Duc G. Massive feto-maternal transfusion during external cephalic version, with fatal outcome. Archiv für Gynakologie 1976; 221: 273–5.

Fries MH, Hankins GD. Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise. Ann Emergency Med 1989; 18: 301–4.

Akanli FL, Cohen-Addad EN, Malabanan VN, Margono F, Krilov AM. Massive fetomaternal hemorrhage. Am J Perinatol 1997; 14: 271–3.

Heise RH, Van Winter JT, Ogburn PL. Identification of acute transplacental hemorrhage in a low-risk patient as a result of daily counting of fetal movements. Mayo Clin Proc 1993; 68: 892–2.

Kosasa TS, Ebesugawa J, Nakayama RT, Hale RW. Massive fetomaternal haemorrhage preceeded by decreased fetal movement and a nonreactive fetal heart rate pattern. Obstet Gynecol 1993; 82: Suppl II: 711–4.

Modanlou HD, Freeman RK. Sinusoidal fetal heart rate pattern: Its definition and clinical significance. Am J Obstet Gynecol 1982; 149: 1033–8.

Del Valle GO, Joffe GM, Izquierdo LA, Smith JF, Kasnic T, Gilson GJ. Acute posttraumatic fetal anemia treated with fetal intravascular transfusion. Am J Obstet Gynecol 1992; 166: 127–9.

Elliott JP, Castro RJ, O’Keeffe DE. Sinusoidal fetal heart rate pattern associated with gastroschisis. Am J Perinatol 1988; 5: 295–6.

Ombelet W, Van der Merwe JV. Sinusoidal fetal heart rate pattern associated with congenital hydrocephalus. A report of 2 cases. S Afr Med J 1985; 67: 423–5.

Cotton DB, Rivera-Alsina M, Palma PA, Schifrin BS. Sinusoidal heart rate pattern in hydranencephaly. A case report. J Reprod Med 1983; 28: 631–3.

Ito T, Maeda K, Takahashi H, Nagata N, Nakajima K, Terakawa N. Differentiation between physiologic and pathologic sinusoidal FHR pattern by fetal actocardiogram. J Perinat Med 1994; 22: 39–43.

Catalano PM, Capeless EL. Fetomaternal bleeding as a cause of recurrent fetal morbidity and mortality. Obstet Gynecol 1990; 76: 972–2.

Završnik T. Vpliv zdravil na kardiotokografski zapis. In: Cerar V, NovakAntolič Ž, Premru-Sršen T eds. Kardiotokografija in druge metode za nadzor plodovega stanja v nosečnosti in med porodom; 17.–19. apr. 1997, Portorož. Ljubljana: Slovensko zdravniško društvo, Združenje za perinatalno medicino, 1997: 78–9.

Japelj I. Kardiotokografija. In: Kurjak A et al. Ginekologija i perinatologija. Varaždinske Toplice: Golden Time, 1995: 205–25.

Cerar V. Kardiotokografija. In: Pajntar M, Novak-Antolič Ž. Nosečnost in vodenje poroda. Ljubljana: Cankarjeva založba, 1994; 286–91.

Hurd WW, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: A prospective study. Obstet Gynecol 1983; 61: 467–73.

De Valera E. Abruptio placentae. Am J Obstet Gynecol 1968; 100: 599–606.

Hibbard BM. Bleeding in late pregnancy. In: Hibbard BM ed. Principles of obstetrics. London: Butterworth & Co. 1988: 669–9.

Sher G. A rational basis for the management of abruptio placentae. J Reprod Med 1978; 21: 123–9.

Cuningham FG et al. Obstetrical hemorrhage. l9th ed. Williams Obstetrics, 1993: 745–79.

Anderson MJ, Higgins PG, Davis LR et al. Experimental parvoviral infection in humans. J Infect Dis 1985; 152: 257–65.

Public Health Laboratory Service Working Party on Fifth Disease. Prospective study of human parvovirus (B 19) infection in pregnancy. Br Med J 1990; 300: 1166–70.

Maraspin-Čarman V. Okužba s humanim parvovirusom B 19 v nosečnosti. Zdrav Vestn 1996; 65: 67–9.

Lizan G, Bordenave C, Sellam R, Berrocal J, de Keyser JL, Muller G. Hemorrhagie foeto-maternelle post-traumatique. J Gynecol Obstet Biol Reprod 1988; 17: 917–21.

Fetal hemoglobin, acid elution, semi-quantitative procedures. Procedure for blood smears procedure No. 285. Sigma Diagnostics 1990.

Schomolling J, Feodorovici C, Ulrich U, Richter O. Fetomaternal macrotarnsfusion after attempted external version. Z Geburtshilfe Neonatol 2001; 205: 200–3.

How to Cite
Domazet-Fink J, Pestevšek M, Novak-Antolič Živa. FETOMATERNAL HAEMORRHAGE – DIFFERENTIAL DIAGNOSIS – CASE REPORT. ZdravVestn [Internet]. 1 [cited 3Apr.2020];71(7/8). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/1605
Professional Article

Most read articles by the same author(s)