BACKGROUND: Massive fetomaternal transplacental hemorrhage is not simplya problem of possible alloimunization in Rh incompatibility but also endangers the fetus (newborn) bymassive anemization. Bleeding from placental vessels can occur after small trauma to the gravid uteruswith mild or no clinical signs (bleeding or spotting, pain, hypertonus). The rupture of anchoring villirelated to early uterine contractions is also possible. In the case of slow blood loss, the fetus reactsby adequate or inadequate compensatory reactions (hydrops fetus). Rapid and massive blood loss is followedby perinatal hypoxic damage and finally death. Our goal was to map out the diagnostic and therapeuticpossibilities in regard to specific neonatal care.
CASE REPORT: We evaluated four cases of fetomaternaltransfusion during a 2-year period with special regard to postpartum adaptation of the newborn and theperinatal outcome. The incidence of adverse outcomes following massive fetomaternal transplacental hemorrhagewas 50% (2 of 4). There was one perinatal death and one infant was affected by spastic quadriplegia.
CONCLUSIONS: For diagnosis, it is possible to use cardiotocography (decreased variability, sinusoid pattern),ultrasound (biophysical profile) and special hematological tests for quantitative determination of fetalerythrocytes in the maternal blood. For the treatment of such cases one should consider premature terminationof pregnancy or intraumbilical transfusion.

Keywords: fetomaternal transplacental hemorrhage, anemization, AB0 fetomaternal compatibility