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Fetomaternal hemorrhage: pathogenesis, diagnosis, and clinical management

Journal of Perinatology volume 46, pages 1599–1607 (2026) Cite this article

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Abstract

Clinically significant fetomaternal hemorrhage (FMH) can have devastating consequences on the newborn infant. Acute FMH close to childbirth can present with hypovolemia, shock, metabolic acidosis, and encephalopathy. Chronic FMH can be associated with congestive heart failure, pulmonary edema, hydrops and hepatomegaly. Early recognition and timely management of FMH are crucial in improving outcomes. This review article summarizes the epidemiology, pathogenesis, diagnosis, management and outcomes of clinically significant FMH. Current knowledge gaps in diagnosis and management of FMH are additionally described.

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Fig. 1: Pathophysiology of acute fetomaternal hemorrhage (FMH).
Fig. 2: Change in hemodynamics during blood loss from fetomaternal circulation.
Fig. 3: Fetoplacental hemorrhage in cases of tight nuchal cord.
Fig. 4: Clinical features in neonates affected by chronic fetomaternal hemorrhage (FMH).
Fig. 5: Biopac snapshot during a 2-minute period of fetal blood loss.

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Acknowledgements

We would like to thank the funding sources listed below.

Funding

The authors have no conflict of interest to declare. This work has been supported by Research Grant from the American Academy of Pediatrics- Neonatal Resuscitation program (AAP-NRP) (DS, and EG), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Institutes of Health HD109443 (DS) and HD072929 (SL), Children’s Miracle Network (DS), and ZOLL Foundation Inc. (DS and EG). The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860 and linked award 5KL2TR001859 (DS), 1K08HL181183-01 (DS), and 5KL2TR001859 (ML). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AAP-NRP. The funder/ sponsor did not participate in planning or devising this work. The authors have no conflict of interest to declare. This work has been supported by Research Grant from the American Academy of Pediatrics- Neonatal Resuscitation program (AAP-NRP) (DS, and EG), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Institutes of Health HD109443 (DS) and HD072929 (SL), National Heart, Lung and Blood Institute (NHLBI) 1K08HL181183-01 (DS), Children’s Miracle Network (DS), and ZOLL Foundation Inc. (DS and EG). The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860 and linked award 5KL2TR001859 (DS) and 5KL2TR001859 (ML). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AAP-NRP. The funder/ sponsor did not participate in planning or devising this work.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Deepika Sankaran, Evan Giusto, Rebecca Valdez & Satyan Lakshminrusimha

  2. Patient Care Services Advanced Practice: Neonatal, University of California Davis, Sacramento, CA, USA

    Evan Giusto

  3. Division of Pediatric Critical Care, Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Michelle J. Lim

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  1. Deepika Sankaran
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  2. Evan Giusto
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  3. Michelle J. Lim
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  4. Rebecca Valdez
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  5. Satyan Lakshminrusimha
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DS conceptualized, designed, drafted the initial manuscript, reviewed and revised the manuscript. EG, ML, and SL contributed to the concept, reviewed and revised the manuscript. All the authors have critically revised and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Deepika Sankaran.

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Sankaran, D., Giusto, E., Lim, M.J. et al. Fetomaternal hemorrhage: pathogenesis, diagnosis, and clinical management. J Perinatol 46, 1599–1607 (2026). https://doi.org/10.1038/s41372-025-02548-y

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