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Virilization of the female fetus with maternal danazol exposure.

suggested the possibility of fetomaternal hemorrhage. In such cases, the possibility that intrapartum hemorrhage may have contributed to the positive KleihauerBetke smear cannot be excluded. This case is unique in several respects. A sinusoidal FHR pattern associated with antepartum documentation of fetomaternal transfusion and fetal anemia has, to our knowledge, not been reported . The degree of fetomaternal transfusion (representing approximately 265 ml of fetal blood) reported here is massive , yet, because of its presumably chronic nature, the infant was fairly well compensated, as evidenced by neonatal hemodynamic stability and absence of ascites on ultrasound. Prolonged anemia with progressive loss of oxygen-carrying capacity may lead to hypoxia and metabolic acidosis. Analysis of such cases has led several authors to postulate hypoxia of the cardiac center with derangement of central nervous system control of the heart rate as the final common pathway in the production of a sinusoidal pattern. This fetus was experiencing neither systemic hypoxia nor acidosis. However, the possibility exists that severe anemia may lead to local, relative hypoxia of specialized tissues such as the central nervous system cardiac center. The uniformly poor neonatal outcome which has been associated with the presence of "true" sinusoidal FHR patterns may be due to the detection of primarily near end-stage cases. The sinusoidal FHR pattern which led to fortuitous intervention after premature rupture of the membranes certainly would not have been apparent with auscultation alone. That the availability of electronic FHR monitoring and the recognition of the significance of the pattern under discussion saved this infant's life seems beyond doubt.