Fetal intracranial hemorrhage (fetal stroke): does grade matter?
Open Access
- 5 August 2005
- journal article
- research article
- Published by Wiley in Ultrasound in Obstetrics & Gynecology
- Vol. 26 (3), 233-243
- https://doi.org/10.1002/uog.1969
Abstract
Objective To determine if the severity of antenatally diagnosed hemorrhagic fetal brain insults and fetal stroke detected by ultrasound and magnetic resonance imaging (MRI) predicts postnatal neurodevelopmental prognosis. Methods The in-utero presentation and postnatal neurodevelopmental outcome of sonographically detected subdural hematoma or fetal stroke presenting as intraventricular hemorrhage (IVH) or intraparenchymal brain hemorrhage were investigated. Results Of 33 fetuses diagnosed with hemorrhagic brain lesions, 17 were electively terminated and two suffered intrauterine fetal demise. Thirteen were liveborn, seven by Cesarean delivery and six by spontaneous vaginal delivery. One case was lost to follow-up. Eight neonates had moderate to severe neurological deficit by a mean age of 35 (range, 6–96) months. One died at 2 months of age. These nine were diagnosed with Grade III–IV IVH in utero. Four neonates had normal neurological outcome by a mean age of 41 (range, 30–48) months; these four were diagnosed with subdural hematoma (n = 1) or Grade I–II IVH (n = 3) in utero. Fourteen cases were followed up with MRI, which confirmed ultrasound findings in 10 (71%) cases. In three (21%) cases MRI diagnosis was more accurate and the severity of grading was greater than that obtained on ultrasound imaging. Unilateral left hemispheric lesions were much more common than right-sided lesions (13 vs. 1, respectively). Conclusions An antenatal sonographic diagnosis of fetal stroke with IVH Grade III–IV or with brain parenchymal involvement appears to be associated with poor neurological outcome. MRI may contribute to the accuracy of diagnosis, particularly in Grade II and III lesions. Left-sided unilateral lesions are more common than right-sided ones. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.Keywords
This publication has 31 references indexed in Scilit:
- Sonographic demonstration of brain injury in fetuses with severe red blood cell alloimmunization undergoing intrauterine transfusionsUltrasound in Obstetrics & Gynecology, 2004
- Is fetal magnetic resonance imaging superior to neurosonography for detection of brain anomalies?Ultrasound in Obstetrics & Gynecology, 2002
- A normal second‐trimester ultrasound does not exclude intracranial structural pathologyUltrasound in Obstetrics & Gynecology, 2002
- The epidemiology of cerebral palsy in term infantsMental Retardation and Developmental Disabilities Research Reviews, 2002
- Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?Ultrasound in Obstetrics & Gynecology, 2001
- Idiopathic Intracranial Haemorrhage in the FetusFetal Diagnosis and Therapy, 1999
- Prenatal sonographic diagnosis of intracranial haemorrhage: Report of a case with a sinusoidal fetal heart rate tracing, and review of the literaturePrenatal Diagnosis, 1995
- Fetal intracranial haemorrhage: clinical significance of in utero ultrasonographic diagnosisBJOG: An International Journal of Obstetrics and Gynaecology, 1993
- Fetal intraventricular hemorrhage: Sonographic diagnosis and clinical implicationsJournal of Clinical Ultrasound, 1983