PMC6815528_01
Electronic fetal heart monitoring (EFM). 14 consecutive (7 min upper, 7 min lower) minutes of EFM are presented. Throughout the EFM periods of sinusoidal and category 2 tracings are noted to alternate without persistence of either pattern. Baseline FHR 150 bpm.
CRIOG2019-4363054.001.jpg
PMC6815528_01_CRIOG2019-4363054.001.jpg
fig1
The patient was found to have alternating category II and III tracing (Figure 1).
Emergent MCA doppler. Shown is the left MCA doppler obtained by maternal fetal medicine staff at time of fluctuating electronic fetal heart monitoring (EFM). Increased MCA Peak Systolic Velocity (PSV) is indicative of severe fetal anemia.
CRIOG2019-4363054.002.jpg
PMC6815528_01_CRIOG2019-4363054.002.jpg
fig2
MCA Doppler. Middle cerebral artery peak systolic velocity was 96 cm/s (1.88MoM) (Figure 2).
Placental histology. High power (40x) H&E staining of the placental terminal villi. Nucleated red blood cells are noted within the terminal villi (black arrows). The presence of nucleated RBCs shows acute fetal hemorrhage within the placenta.
CRIOG2019-4363054.003.jpg
PMC6815528_01_CRIOG2019-4363054.003.jpg
fig3
Placental pathology revealed a 368 g, appropriate for gestational age placenta with increased circulating nucleated red blood cells and focal chronic villitis (Figure 3).