Massive Fetomaternal haemorrhage (FMH) of more than 30 ml can cause significant fetal morbidity and mortality. Reduced fetal movements can be the only presenting symptom.
There is no consensus among obstetricians regarding the optimum management of reduced foetal movements. The most common investigations performed are cardiotocography (CTG), Ultrasound scan (USS) and umbilical artery Doppler (UAD).
We present two cases of FMH, of 68.4 ml and 57.1 ml detected by Kleihauer test. Reduced fetal movements were the only presenting symptom.
Although the CTG findings were suspicious, the clinical staff were reassured by the normal USS and UAD results. Subsequently, both babies demised in utero.
Silent FMH is an unpredictable event, occurs at any gestation and can be fatal. CTG should be interpreted carefully as this might be the only sign of even massive FMH as in our cases.
We suggest the use of Kleihauer test in such cases to aid the diagnosis of FMH. This may help with earlier identification of patients to allow timely intervention. However; further studies are needed to investigate the value of this test in the management of reduced fetal movements.
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