EMERGENCY CESAREAN SECTION FOR A RARE LIFE-THREATENING FETAL PATHOLOGY

Mihaela  Amza; Fernanda-Ecaterina  Augustin; Tina-Ioana  Bobei; Cristina-Diana  Popescu; Romina-Marina  Sima; Liana  Pleș; Ileana-Maria  Conea

doi:10.33695/rojes.v5i1.75

Mihaela Amza Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania & The “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Fernanda-Ecaterina Augustin “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Tina-Ioana Bobei Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania & “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Cristina-Diana Popescu “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Romina-Marina Sima Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania & “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Liana Pleș Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania & “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania
Ileana-Maria Conea Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania & “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania

DOI: https://doi.org/10.33695/rojes.v5i1.75

Keywords: cesarean section, alloimmunization, emergency

Abstract

Nowadays, fetal anemia is a rare cause of fetal hypoxia because the widely used ultrasound helps to identify it and makes antepartum management possible. We present a case of a 34-week pregnant woman with Rh incompatibility and alloimmunization associated with severe fetal anemia. In this case, urgent decision was needed to save the life of the fetus. A 24-year-old patient, G5 P2, 34 weeks pregnant, was presented to our emergency room for the lack of perception of active fetal movements for 24 hours. We mentioned that she was known to have Rh incompatibility and the last determination of anti Rh antibodies had a titer of 1:8 at 32 weeks of pregnancy. The ultrasound scan found modified values of the parameters on the middle cerebral artery indicating the presence of fetal anemia according to FMF (Fetal Medicine Foundation) algorithm for prediction anemia with an estimated fetal hemoglobin < 1.5 g/dl. Repeated CTGs indicated the presence of non-reassuring fetal status. An emergency cesarean delivery was decided to save the life of the fetus, which weighed 2600 g, had an Apgar index of 4 and a hemoglobin of 2.8 g/dl. The newborn showed signs of cardiomegaly, hepatomegaly, ascites and hydrops. The evolution of the newborn was favorable and he was discharged 14 days after birth. In conclusion, the ultrasound follow-up of patients with Rh incompatibility and alloimmunization is very important for the timely detection of possible changes in Doppler parameters. In a few cases, severe fetal anemia and non-reassuring fetal status occur, which indicates emergency cesarean section.

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