The associations of fetomaternal hemorrhage with fetal growth restriction and umbilical cord abnormalities: A nationwide observational study

Abstract

Objective: Fetomaternal hemorrhage (FMH) causes severe neonatal outcomes; however, due to its rarity, risk factors for FMH occurrence and prognostic factors for its outcomes remain unclear. Thus, we aimed to investigate factors for FMH occurrence and related outcomes.

Materials and methods: We included singleton pregnant women from the Japanese nationwide perinatal registry database between 2013 and 2019. To investigate the association between characteristics and FMH occurrence, we conducted multivariable logistic regression model analyses. In addition, we employed multivariable logistic regression models to evaluate prognostic factors of stillbirth or neonatal death among FMH. We used multiple imputation to handle missing data in all analyses.

Results: Of 1,500,309 women, FMH occurred in 141 (1/10,640). A sinusoidal pattern was detected in only 20.6 % of women with FMH. The proportion of women who had fetal growth restriction (FGR) was 10/141 (7.1 %) in those with FMH and 54,989/1,500,168 (3.7 %) in those without FMH. A single umbilical artery was found in 2/141 (1.4 %) and 3845/1,500,168 (0.3 %) women with and without FMH, respectively. FGR and a single umbilical artery were significantly associated with FMH occurrence (adjusted odds ratio [OR], 2.01; 95 % confidence interval [CI], 1.06-3.83; p = 0.033) (adjusted OR, 5.51; 95 % CI, 1.36-22.27; p = 0.017), respectively. In addition, abnormal umbilical cord insertion was significantly associated with stillbirth or neonatal death among FMH (adjusted OR, 19.95; 95 % CI, 2.33-170.63; p = 0.006).

Conclusion: The occurrence of FMH was significantly associated with FGR and a single umbilical artery. In addition, abnormal umbilical cord insertion was significantly associated with stillbirth or neonatal death among those with FMH. We need to be cautious regarding FMH occurrence in women with FGR or a single umbilical artery. In addition, perinatal outcomes in women with FMH, especially those with abnormal umbilical cord insertion, would be adverse.

Keywords: Cardiotocography; Fetal growth restriction; Fetomaternal hemorrhage; Neonatal death; Single umbilical artery; Stillbirth.