We report a pregnant 30 years, 3 para 2, who came at 39 w in our hospital due to reduced fetal movements, had Hb was 8.8g/dL. He did not do iron therapy; the blood type was RH negative and had not done immunoprophylaxis at 28 w. NST was a non-reactive without decelerations, we did ultrasound after 20 minutes, there was normal biometry, normal AFI. Doppler showed normal flow in the umbilical artery PI 0.84, normal flow in the middle cerebral artery PI 3.86 and the peak of flow velocity (VPS) was normal 45.9 cm/. A Caesarean section was done and a female fetus was delivered after 3 hours: the fetus was pale, atonic and required intensive resuscitation. PH venosus 7.27, BE-8,6mmol/L,Hb4,2g/dL -PH arteriosus 6.91,BE-13,1mmol/L,Hb4,1g/dL. After 40 minutes the anesthetist stopped resuscitation. The child's blood type was Rh positive and the Coombs test was negative; Kleihauer's test was positive and the flow cytometry was 220cc. In recent studies it seems important to evaluate the VPS, an increased VPS > 1.5MoM is associated with severe fetal anemia; in our case we cannot suspect anemia because VPS was normal. In case of anemia the blood velocity increases according to the viscosity decreases, in this scenario blood flow decreases. However, if a simultaneous blood mass reduction is present, a positive vessel remodelling (vasoconstriction) can occur in order to maintain vessel contractility. This last aspect can produce an overall reduction of the area of the vessels. The combined effect of the increased velocity and area reduction can produce an overall preservation of the normal blood flow. This equation described the phenomenon: Blood Flow = Velocity Blood x Vessel Area. But if it is present a significant reduction of blood flow and reduction of the area of the vessels the velocity blood decreases; in our case the VPS was normal despite the severe anemia determined, however not only by the lack of the corpuscular part but above all by the massive loss of blood volume.

EP24.13: Fetomaternal hemorrhage: a new hypothesis on the importance of fetal vasoconstriction – a case report

A. Ragusa;
2022-01-01

Abstract

We report a pregnant 30 years, 3 para 2, who came at 39 w in our hospital due to reduced fetal movements, had Hb was 8.8g/dL. He did not do iron therapy; the blood type was RH negative and had not done immunoprophylaxis at 28 w. NST was a non-reactive without decelerations, we did ultrasound after 20 minutes, there was normal biometry, normal AFI. Doppler showed normal flow in the umbilical artery PI 0.84, normal flow in the middle cerebral artery PI 3.86 and the peak of flow velocity (VPS) was normal 45.9 cm/. A Caesarean section was done and a female fetus was delivered after 3 hours: the fetus was pale, atonic and required intensive resuscitation. PH venosus 7.27, BE-8,6mmol/L,Hb4,2g/dL -PH arteriosus 6.91,BE-13,1mmol/L,Hb4,1g/dL. After 40 minutes the anesthetist stopped resuscitation. The child's blood type was Rh positive and the Coombs test was negative; Kleihauer's test was positive and the flow cytometry was 220cc. In recent studies it seems important to evaluate the VPS, an increased VPS > 1.5MoM is associated with severe fetal anemia; in our case we cannot suspect anemia because VPS was normal. In case of anemia the blood velocity increases according to the viscosity decreases, in this scenario blood flow decreases. However, if a simultaneous blood mass reduction is present, a positive vessel remodelling (vasoconstriction) can occur in order to maintain vessel contractility. This last aspect can produce an overall reduction of the area of the vessels. The combined effect of the increased velocity and area reduction can produce an overall preservation of the normal blood flow. This equation described the phenomenon: Blood Flow = Velocity Blood x Vessel Area. But if it is present a significant reduction of blood flow and reduction of the area of the vessels the velocity blood decreases; in our case the VPS was normal despite the severe anemia determined, however not only by the lack of the corpuscular part but above all by the massive loss of blood volume.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/69783
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