Fetomaternal hemorrhage (FMH) is an obstetric emergency characterized by the pathological transfer of fetal erythrocytes across the placental barrier into the maternal circulation. FMH can lead to severe complications, including fetal anemia, non-immune hydrops, and perinatal mortality. The pathogenesis involves multifactorial interactions, such as placental barrier dysfunction, hemodynamic abnormalities, and vascular endothelial injury. Due to its insidious clinical presentation and limitations in current diagnostic modalities, FMH is prone to missed or delayed diagnosis. This study presents a case of intrauterine fetal demise secondary to FMH and conducts a narrative literature review to establish an early warning indicator system, refine risk assessment models, and propose evidence-based individualized intervention strategies. The objectives are to enhance clinical recognition, standardize diagnostic and therapeutic protocols, and ultimately improve perinatal outcomes.
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