Notching in the Umbilical Artery Doppler Waveform in the Absence of Cord and Placental Structural Abnormalities: A Case of Massive Fetomaternal Hemorrhage

Abstract

Massive fetomaternal hemorrhage can cause severe anemia and fetal death. Early diagnosis and blood transfusion can prevent life-threatening events. We describe a case of massive fetomaternal hemorrhage in a previously well primigravida who visited our hospital with a chief complaint of decreased fetal movements and presented with a sinusoidal fetal heart rate pattern in the cardiotocographic tracings. The umbilical artery Doppler waveform showed notching, and the peak systolic velocity of the fetal middle cerebral artery (MCA) was normal. Emergency cesarean section was performed; however, the neonate died despite providing life-support. Thus, we recommend consideration of impending fetal death in patients with non-reassuring fetal heart rate and notching in the umbilical artery Doppler waveform even in the absence of increased peak systolic velocity of the fetal MCA.




J Clin Gynecol Obstet. 2016;5(1):50-52
doi: http://dx.doi.org/10.14740/jcgo386w