Objective

To investigate the perinatal outcomes of fetomaternal hemorrhage（FMH）syndrome pregnant women with sinusoidal fetal heart tracing.

Methods

Four FMH syndrome pregnant women （pregnant women 1-4）with sinusoidal fetal heart tracing were selected from January 2018 to April 2022 in Department of Obstetrics，West China Second University Hospital，Sichuan University.Clinical data such as the general clinical data，clinical manifestations，and laboratory test results of all pregnant women，fetal electronic heart rate monitoring images，basic conditions of newborns，treatment outcomes and prognosis of newborns were collected by retrospective analysis method.The procedures followed in this study were in line with the Helsinki Declaration of the World Medical Association

Results

The clinical data of pregnant women 1-4 and their neonates were analyzed as follows.①Among 4 pregnant women with FMH syndrome，pregnant woman 1 was twins and pregnant women 2-4 were singletons，and neonates 1-2 were born by pregnant woman 1，neonates 3-5 were born by pregnant women 2-4；pregnant women 1-3 complained of reduced fetal movement （RFM）.Maternal blood alpha-fetoprotein（AFP）levels of pregnant women 1-4 ranged from 2 923.6-26 736.1 ng/m L，abnormally higher than normal value.Maternal blood hemoglobin（Hb）electrophoresis of pregnant women 1-4 showed that HbF content ranged from 3.7%to 6.4%，higher than normal value，and except for pregnant woman 4 whose Hb A2 content was 1.2%，which was lower than normal values，the Hb A2 content of the other three pregnant women was normal.All pregnant women were with sinusoidal fetal heart tracing and were terminated by emergency cesarean section within 8 to 108 minutes after the discovery of abnormal electronic fetal heart monitoring.The gestational age of delivery was 33⁺⁵ to 37⁺⁶ gestational weeks.Postpartum placental histopathology showed that pregnant women 1 and 3 had pale and edema placenta，pregnant woman 4 had amniotic epithelial degeneration，and pregnant women 1-3 had mild chorioamnionitis.②Neonates 1-5 were transferred to the neonatal intensive care unit （NICU）.Neonates 1-2 and 4 had intrauterine fetal distress and neonatal asphyxia.Neonate 3 died at 5.07 h after birth due to extremely severe anemia combined with multiple organ failure after active rescue treatment.The other four neonates all recovered and were discharged from hospital.

Conclusions

FMH syndrome is rare，prenatal diagnosis is difficult，the key to clinical treatment of FMH syndrome is early detection，early d iagnosis，timely treatment，correction of fetal or neonatal anemia，so as to improve perinatal survival rate and prognosis of pregnant women and newborns.