Obstet Gynecol Sci.  2024 Jul;67(4):393-403. 10.5468/ogs.24097.

Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage: a single-center experience

• Kim S
• Jung YJ
• Baik J
• Kwon H
• Lee J
• Kwon JY
• Kim YH

• KMID: 2557856
• DOI: http://doi.org/10.5468/ogs.24097

Abstract

Objective
To assess prenatal ultrasonographic findings and postnatal outcomes in fetuses with intracranial hemorrhage (ICH).
Methods
This retrospective study included fetuses prenatally diagnosed with ICH between December 2012 and August 2023. Maternal characteristics, prenatal ultrasonographic findings, and postnatal outcomes were reviewed.
Results
Twenty-seven fetuses with ICH were reviewed. Intracranial hemorrhage was classified as grade 3 and 4 in 24 fetuses. Twenty-two fetuses had ICH, four had ICH with subdural hemorrhage, and one had ICH with subarachnoid hemorrhage. Ventriculomegaly was the most common ultrasonographic finding, and was observed in 22 of the 27 (81.5%) fetuses. Seven fetuses were lost to follow-up, and four intrauterine fetal deaths occurred. The remaining 16 fetuses were delivered at a median gestational age of 35+2 weeks. The infants were followed-up for 40.1 months (range, 4-88). Nine of the 16 infants underwent ventriculoperitoneal placement. One infant underwent brain surgery for severe epilepsy. Motor impairment, including cerebral palsy, was observed in 13 infants (81.2%). Neurologic impairment occurred in six infants (37.5%), developmental delay in nine (56.2%), and epilepsy in 11 (68.7%).
Conclusion
Fetal ICH is a rare complication diagnosed during pregnancy, which results in subsequent fetal neurological sequelae or death. This study demonstrated that the common ultrasonographic findings in fetal ICH were progressive ventriculomegaly and increased periventricular echogenicity. Fetuses diagnosed with prenatal ICH, especially those affected by higher-grade ICH, may be at an increased risk of long-term neurodevelopmental problems.

Keyword

Nervous system malformations; Intracranial hemorrhages; Prenatal diagnosis; Ultrasonography

Figure

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  Fig. 1. Image showing subdural hemorrhage. Patient was referred to our hospital due to a history of previous intrauterine fetal death (IUFD). First visit at 26 weeks showed IUFD, ventriculomegaly, left subdural space hemorrhage (arrow), right temporoparietal area hemorrhage (arrowhead), fetal ascites, pleural effusion, scalp edema, and intracardiac hematoma. After hysterotomy, cord next generation sequencing and parental gene screening was performed, but significant result were not found.

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  Fig. 2. Image demonstrating progressive ventriculomegaly. Ultrasound image (left) showing left ventriculomegaly with a hyperechogenic blood clot in the lateral ventricle. Magnetic resonance imaging (right) showing the same results, indicating ventriculomegaly (arrow) and a hyperechogenic blood clot (arrowhead).

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  Fig. 3. Image showing increased periventricular echogenicity. Increased periventricular echogenicity accompanied by severe bilateral ventriculomegaly (both sides >30 mm).

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  Fig. 4. Image demonstrating echogenic intraventricular clot. Ultrasound image showing an echogenic space-occupying lesion. A blood clot (1.2×0.6 cm) was noted in the ventricle with unilateral ventriculomegaly. Postnatal magnetic resonance imaging confirmed the presence of an old intraventricular hemorrhage.

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  Fig. 5. Image showing an irregular shaped choroid plexus. The patient showed an irregular choroid plexus (arrowhead) with severe bilateral ventriculomegaly and increased periventricular echogenicity.

Reference

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