{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:47:06Z","timestamp":1791852426053,"version":"4.3.4"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Geburtshilfe Neonatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fetomaternal hemorrhage refers to the transfer of fetal erythrocytes into the\n                    maternal circulation. Although clinically significant fetomaternal hemorrhage is\n                    rare, it can result in severe fetal anemia with substantial morbidity and\n                    mortality. Early recognition remains challenging due to a nonspecific clinical\n                    presentation. This study aimed to identify maternal and obstetric\n                    characteristics associated with fetomaternal hemorrhage that may serve as early\n                    clinical warning signs. In this retrospective multicenter descriptive study,\n                    singleton pregnancies with a positive Kleihauer\u2013Betke test from five obstetric\n                    care centers in Berlin (2009\u20132026) were analyzed. Clinical and demographic data\n                    were evaluated descriptively. A total of 39 cases were included. The mean\n                    maternal age was 31.9 years and the mean gestational age at delivery was 37.3\n                    weeks. Pathological cardiotocography was observed in 79% of cases, including 42%\n                    with a sinusoidal pattern. Reduced fetal movements were reported in 51% of\n                    cases. Elevated middle cerebral artery peak systolic velocity, suggestive of\n                    fetal anemia, was documented in 50% of cases with an overall documentation rate\n                    of 31%; abdominal trauma was present in 15% of cases. Caesarean section was\n                    performed in 82% of cases, including 31% emergency procedures. Intrauterine\n                    fetal death occurred in 5% of cases. Reduced fetal movements and abnormal\n                    cardiotocography patterns, particularly sinusoidal tracings, represent key\n                    clinical warning signs of fetomaternal hemorrhage and should prompt immediate\n                    diagnostic evaluation. Given the small sample size, findings are exploratory.\n                    Prospective studies are needed to establish validated risk profiles and\n                    diagnostic pathways.<\/jats:p>","DOI":"10.1055\/a-2956-7192","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:59:02Z","timestamp":1791849542000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics Associated with Fetomaternal Hemorrhage: A Retrospective Multicenter Descriptive Study (2009\u20132026)"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0064-5189","authenticated-orcid":false,"given":"Vanessa Ande","family":"Ruan","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum im Friedrichshain, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Gyn\u00e4kologie und Geburtshilfe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kummer","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum im Friedrichshain, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Gyn\u00e4kologie und Geburtshilfe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Simon","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum im Friedrichshain, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Gyn\u00e4kologie und Geburtshilfe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Fioravanti","sequence":"additional","affiliation":[{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Geburtsmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Hellmeyer","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum im Friedrichshain, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Gyn\u00e4kologie und Geburtshilfe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Schlembach","sequence":"additional","affiliation":[{"name":"Vivantes Klinikum Neuk\u00f6lln, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Geburtsmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4817-3368","authenticated-orcid":false,"given":"Josefine","family":"K\u00f6nigbauer","sequence":"additional","affiliation":[{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Germany","place":["Berlin"],"department":["Klinik f\u00fcr Geburtsmedizin"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.1423-0410.1986.tb00226.x","article-title":"Fetomaternal transplacental hemorrhage during pregnancy and after delivery","volume":"51","author":"J M Bowman","year":"1986","journal-title":"Vox Sang"},{"issue":"09","key":"ref2","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1038\/s41372-025-02548-y","article-title":"Fetomaternal hemorrhage: pathogenesis, diagnosis, and clinical management","volume":"46","author":"D Sankaran","year":"2026","journal-title":"J Perinatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1111\/j.1471-0528.1988.tb06792.x","article-title":"Fetomaternal macrotransfusion in the Yorkshire region. 1. Prevalence and\n                    obstetric factors","volume":"95","author":"T C Li","year":"1988","journal-title":"Br J Obstet Gynaecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1038\/jp.2012.142","article-title":"Severe neonatal anemia from fetomaternal hemorrhage: report from a multihospital\n                    health-care system","volume":"33","author":"R D Christensen","year":"2013","journal-title":"J Perinatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1097\/01.AOG.0000271212.66040.70","article-title":"Long-term prognosis for infants after massive fetomaternal hemorrhage","volume":"110","author":"C Rubod","year":"2007","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"102","DOI":"10.2350\/13-12-1419-OA.1","article-title":"Pathological findings in feto-maternal hemorrhage","volume":"17","author":"D Carles","year":"2014","journal-title":"Pediatr Dev Pathol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1111\/trf.16710","article-title":"Fetomaternal hemorrhage: evidence from a multihospital healthcare system that up\n                    to 40% of severe cases are missed","volume":"62","author":"N R Carr","year":"2022","journal-title":"Transfusion"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1097\/AOG.0b013e3181da7929","article-title":"Fetomaternal hemorrhage","volume":"115","author":"B J Wylie","year":"2010","journal-title":"Obstet Gynecol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1159\/000443718","article-title":"Fetomaternal hemorrhage: mostly a hidden hazard","volume":"109","author":"M E D\u2019Alton","year":"2016","journal-title":"Neonatology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000446109","article-title":"Diagnosis of severe fetomaternal hemorrhage with fetal cerebral doppler: case\n                    series and systematic review","volume":"41","author":"F Bellussi","year":"2017","journal-title":"Fetal Diagn Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/j.ajog.2004.01.007","article-title":"Quantification of fetomaternal hemorrhage: a comparative study of the manual and\n                    automated microscopic Kleihauer-Betke tests and flow cytometry in clinical\n                    samples","volume":"191","author":"D M Pelikan","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1111\/tme.12030","article-title":"Quantitation of fetomaternal haemorrhage and F cells in unusual maternal blood\n                    samples by flow cytometry using anti-D and anti-HbF","volume":"23","author":"B M Kumpel","year":"2013","journal-title":"Transfus Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1159\/000357797","article-title":"Impact of physician awareness on diagnosis of fetomaternal hemorrhage","volume":"105","author":"A Stroustrup","year":"2014","journal-title":"Neonatology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1159\/000442082","article-title":"Demographic and behavioral predictors of severe fetomaternal hemorrhage: a\n                    case-control study","volume":"109","author":"A Stroustrup","year":"2016","journal-title":"Neonatology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1002\/jcu.24062","article-title":"Diagnosis of spontaneous massive fetomaternal hemorrhage: a case report and\n                    literature review","volume":"53","author":"M Derme","year":"2025","journal-title":"J Clin Ultrasound"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1423786","article-title":"Case report: fetomaternal hemorrhage and its association with pronounced\n                    neonatal anemia","volume":"12","author":"P Li","year":"2024","journal-title":"Front Pediatr"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s00404-015-3686-1","article-title":"Fetomaternal hemorrhage (FMH), an update: review of literature and an\n                    illustrative case","volume":"292","author":"J T Maier","year":"2015","journal-title":"Arch Gynecol Obstet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e197","DOI":"10.1016\/j.ajog.2025.06.027","article-title":"Interpreting fetal heart rate monitoring in undiagnosed severe fetal\n                    anemia-rethinking the sinusoidal pattern","volume":"233","author":"M Anteby","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"102S","DOI":"10.1097\/01.Aog.0000558803.79128.07","article-title":"Clinically significant fetomaternal hemorrhage: incidence and recurrence rate\n                    [26I]","volume":"133","author":"M J Boller","year":"2019","journal-title":"Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/AOG.0b013e3181aef106","article-title":"ACOG practice bulletin no. 106: intrapartum fetal heart rate monitoring:\n                    nomenclature, interpretation, and general management principles","volume":"114","author":"[Anonym]","year":"2009","journal-title":"Obstet Gynecol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"296463","DOI":"10.1155\/2014\/296463","article-title":"Acute and chronic fetal anemia as a result of fetomaternal hemorrhage","volume":"2014","author":"P Singh","year":"2014","journal-title":"Case Rep Obstet Gynecol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1056\/NEJMoa052855","article-title":"Doppler ultrasonography versus amniocentesis to predict fetal anemia","volume":"355","author":"D Oepkes","year":"2006","journal-title":"N Engl J Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1002\/uog.1882","article-title":"Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia:\n                    the untold story","volume":"25","author":"G Mari","year":"2005","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.2298\/VSP150605130D","article-title":"Massive fetomaternal hemorrhage as a cause of severe fetal anemia","volume":"73","author":"A Dobrosavljevic","year":"2016","journal-title":"Vojnosanit Pregl"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1136\/archdischild-2024-328135","article-title":"Cerebral injury and long-term neurodevelopment impairment in children following\n                    severe fetomaternal transfusion: a retrospective cohort study","volume":"110","author":"S El Emrani","year":"2025","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.4038\/sljog.v45i3.8106","article-title":"Managing reduced fetal movements","volume":"45","author":"S H Dodampahala","year":"2023","journal-title":"Sri Lanka J Obstet Gynaecol"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1515\/crpm-2021-0079","article-title":"Massive fetomaternal hemorrhage: a case series and review of literature","volume":"11","author":"C Smet","year":"2022","journal-title":"Case Rep Perinat Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jgyn.2007.08.008","article-title":"[Use of peak systolic velocity of the middle cerebral artery in the management\n                    of fetal anemia due to fetomaternal erythrocyte alloimmunization]","volume":"37","author":"B Carbonne","year":"2008","journal-title":"J Gynecol Obstet Biol Reprod (Paris)"},{"key":"ref29","first-page":"1727","article-title":"[Minor trauma during pregnancy can cause severe fetomaternal hemorrhage]","volume":"127","author":"M Tarvonen","year":"2011","journal-title":"Duodecim"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.gofs.2017.08.009","article-title":"Trauma and pregnancy: Is the Kleihauer-Betke test really useful?","volume":"45","author":"M Girard","year":"2017","journal-title":"Gynecol Obstet Fertil Senol"}],"container-title":["Zeitschrift f\u00fcr Geburtshilfe und Neonatologie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2956-7192.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:59:02Z","timestamp":1791849542000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2956-7192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1055\/a-2956-7192","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0948-2393","1439-1651"],"issn-type":[{"value":"0948-2393","type":"print"},{"value":"1439-1651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]}}}