Does Fetomaternal Hemorrhage Tend to Reoccur in Subsequent Pregnancies?
BACKGROUND AND PURPOSE:
Whether a history of fetomaternal hemorrhage is associated with an increased risk for recurrence in subsequent pregnancies is unknown
Boller et al. (AJOG) investigated the recurrence rate of fetomaternal hemorrhage in a large integrated healthcare system over a 10-year period
Cases of fetomaternal hemorrhage (between 2008 and 2018)
Fetomaternal hemorrhage definition
Elevated fetal hemoglobin level, using flow cytometry, for a concerning pregnancy outcome (preterm delivery, perinatal demise, neonatal anemia, or transfusion within the first 2 days of life)
Perinatal demise with autopsy findings suggestive of fetomaternal hemorrhage
Subsequent pregnancies with recurrent fetomaternal hemorrhage
375,864 deliveries | 20,582 fetal hemoglobin flow cytometry tests were performed
Cases of fetomaternal hemorrhage: 340
Incidence of fetomaternal hemorrhage: approximately 1 in every 1100 births
Index fetomaternal hemorrhage outcomes
Incidence of perinatal loss with fetomaternal hemorrhage: 23.5%
Incidence of transfusion requirement with fetomaternal hemorrhage: 14.7%
Flow cytometry values were predictive of FMH
Preterm: >1.0% was associated with a positive predictive value of 100% (95% CI, 88.1 to 100)
Term deliveries: >5.0% was associated with a positive predictive value of 100% (95% CI, 81.5 to 100)
Subsequent pregnancies from index cases
Number of subsequent pregnancies: 225
174 advanced to viability and were delivered
Recurrent cases of fetomaternal hemorrhage: 1
Spontaneous preterm delivery with elevated reticulocyte count but clinically well
Fetomaternal hemorrhage incidence was approximately 1 per 1100 pregnancies
Rate of fetomaternal hemorrhage recurrence in subsequent pregnancies was 0.5%
The authors state
Clinicians can continue to counsel patients that the risk of recurrence of FMH is low and that the vast majority of patients go on to have term deliveries of liveborn infants
Clinicians must maintain a high index of clinical suspicion for FMH in cases of otherwise unexplained fetal demise or neonatal hypovolemia to perform timely testing for fetal hemoglobin in maternal circulation
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