Fetal heart rate response to acute hemorrhage.

Intrapartum fetal bleeding from an anomalous umbilical cord vessel has been associated with a perinatal mortality rate of over 50%. Fetal blood volume is relatively small. Thus, an insignificant hemorrhage by adult standards may quickly lead to fetal shock and death. This paper documents the fetal heart rate (FHR) response to acute intrapartum hemorrhage. The onset of fetal bleeding is marked by a tachycardia followed by a bradycardia with intermittent accelerations or decelerations. Small amounts of vaginal bleeding associated with FHR abnormalities should raise the suspicion of fetal hemorrhage. This condition demands prompt delivery and immediate reexpansion of the neonatal blood volume.