Disorders of the fetomaternal unit

doi:10.1017/CBO9780511545306.004

2 - Disorders of the fetomaternal unit

Published online by Cambridge University Press: 10 August 2009

Eric J. Werner

Edited by

Pedro A. de Alarcón and

Eric J. Werner

Foreword by

J. Lawrence Naiman

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Eric J. Werner: Affiliation:
M.D. Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA, USA
Pedro A. de Alarcón: Affiliation:
University of Tennessee
Eric J. Werner: Affiliation:
Eastern Virginia Medical School
J. Lawrence Naiman: Affiliation:
Stanford University School of Medicine, California

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Summary

In health, the placenta functions marvelously well as the interface between the maternal and fetal circulations, providing nutrition, oxygen, fluid, and electrolytes and removing fetal waste and carbon dioxide. Disorders that disrupt placental physiology, and the presence of pathogens or toxins that can cross the placental barrier, can adversely affect the fetus. This chapter will discuss disorders of the maternal–fetal unit that result in hematologic abnormalities in the fetus and/or newborn infant.

Hemorrhagic disorders of the fetoplacental unit

The average blood volume of the fetoplacental circulation is roughly 110 ml/kg [1], and hence a relatively small amount of blood loss can be a sizable proportion of the fetal blood volume. Placental abnormalities causing fetal blood loss are shown in Table 2.1. Such blood loss can be visible, as with placenta previa, or occult, as with fetomaternal bleeds or twin–twin transfusion syndrome. The clinician must suspect fetal blood loss if the neonate presents with shock and pallor. The placenta and cord should be inspected for pallor, a hematoma, or other anomalies. As discussed below, maternal blood should be studied for the presence of fetal cells.

Abruptio placenta and placenta previa

While the majority of blood loss with placenta previa or abruptio placenta is maternal, fetal blood loss can also occur [2, 3]. The frequency of neonatal anemia requiring transfusion increases with the severity of maternal bleeding [4].

Type: Chapter
Information: Neonatal Hematology , pp. 10 - 39

DOI: https://doi.org/10.1017/CBO9780511545306.004 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

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