Fetal Intracranial Hemorrhage: Prenatal Sonographic Diagnosis Criteria and Postnatal Outcomes

Overview

Journal J Turk Ger Gynecol Assoc

Publisher Galenos Publishing House

Specialty Gynecology & Obstetrics

Date 2022 Mar 10

PMID 35266380

Authors

Zeynep Gedik Ozkose

Suleyman Cemil Oglak

Aysegul Bestel

Mustafa Behram

Sema Suzen Caypinar

Fatma Olmez

Ismail Ozdemir

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study was to improve knowledge of prenatally diagnosed fetal intracranial hemorrhage (ICH), defining the ultrasound (US) examination results, the contribution of fetal magnetic resonance imagination (MRI) to the diagnosis, and the pregnancy outcomes, from a series of fetal ICH cases.

Material And Methods: This retrospective, observational study included eleven fetuses diagnosed with ICH from April 2016 to August 2020. The data regarding the medical records, prenatal US and MRI findings, treatment, and prognosis of fetal ICH cases were collected from the hospital database and analyzed.

Results: Fetal ICHs were grade 3 in six cases, and grade 4 in the remaining five cases. The mean gestational age at diagnosis was 30.2 weeks. Nine (81.8%) of the cases were diagnosed in the third trimester and two (18.2%) in the second trimester. Fetal cranial MRI was performed in 7/11 (63.6%) following ultrasonographic diagnosis. MRI confirmed fetal ICH diagnosis and previous US findings regarding location and grade in all cases. Five patients (45.5%) diagnosed with grade 3 (n=1) and grade 4 (n=4) ICH underwent pregnancy termination. Of the remaining six cases, one (9.1%) diagnosed with grade 3 fetal ICH resulted in an intrauterine fetal demise. Four cases classified as grade 3 fetal ICH and one case with grade 4 fetal ICH were born alive at term.

Conclusion: The clinical manifestations of fetal ICH are diverse and have a wide spectrum of severity and prognostic implications. Fetal ICH cases were mainly detected in the third trimester, with a minority detected in the second trimester. These cases can be safely diagnosed and graded by US examination, but the underlying etiology frequently cannot be determined. Fetal cranial MRI may aid in diagnosis confirmation if this is unclear from US in order to provide appropriate counseling to the parents.

Citing Articles

Intracranial hemorrhage and additional anomalies detected on prenatal magnetic resonance imaging: A large, retrospective study in two tertiary medical institutions.

Zhu H, Wang T, Lu Y, Huang X, Bai Y, Zhang G Heliyon. 2025; 10(24):e41037.

PMID: 39759338 PMC: 11696780. DOI: 10.1016/j.heliyon.2024.e41037.

Fetal intracranial hemorrhage and infarct: Main sonographic and MRI characteristics: A review article.

Moradi B, Ardestani R, Shirazi M, Eslamian L, Kazemi M Eur J Obstet Gynecol Reprod Biol X. 2024; 24:100351.

PMID: 39610469 PMC: 11603015. DOI: 10.1016/j.eurox.2024.100351.

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

Kim S, Jung Y, Baik J, Kwon H, Lee J, Kwon J Obstet Gynecol Sci. 2024; 67(4):393-403.

PMID: 38898776 PMC: 11266850. DOI: 10.5468/ogs.24097.

References

Ghi T, Simonazzi G, Perolo A, Savelli L, Sandri F, Bernardi B . Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature. Ultrasound Obstet Gynecol. 2003; 22(2):121-30. DOI: 10.1002/uog.191. View

Winkelhorst D, Kamphuis M, Steggerda S, Rijken M, Oepkes D, Lopriore E . Perinatal Outcome and Long-Term Neurodevelopment after Intracranial Haemorrhage due to Fetal and Neonatal Alloimmune Thrombocytopenia. Fetal Diagn Ther. 2018; 45(3):184-191. PMC: 6482979. DOI: 10.1159/000488280. View

Monteagudo A . Intracranial Hemorrhage. Am J Obstet Gynecol. 2020; 223(6):B34-B37. DOI: 10.1016/j.ajog.2020.08.183. View

Pooh R, Kurjak A . Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester. J Perinat Med. 2014; 43(2):147-58. DOI: 10.1515/jpm-2014-0157. View

Anderson M, McGahan J . Sonographic detection of an in utero intracranial hemorrhage in the second trimester. J Ultrasound Med. 1994; 13(4):315-8. DOI: 10.7863/jum.1994.13.4.315. View

Adiego B, Martinez-Ten P, Bermejo C, Estevez M, Recio Rodriguez M, Illescas T . Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes. J Matern Fetal Neonatal Med. 2017; 32(1):21-30. DOI: 10.1080/14767058.2017.1369521. View

Jocelyn L, Casiro O . Neurodevelopmental outcome of term infants with intraventricular hemorrhage. Am J Dis Child. 1992; 146(2):194-7. DOI: 10.1001/archpedi.1992.02160140060021. View

Abdelkader M, Ramadan W, Gabr A, Kamel A, Abdelrahman R . Fetal intracranial hemorrhage: sonographic criteria and merits of prenatal diagnosis. J Matern Fetal Neonatal Med. 2016; 30(18):2250-2256. DOI: 10.1080/14767058.2016.1245283. View

Kutuk M, Yikilmaz A, Ozgun M, Dolanbay M, Canpolat M, Uludag S . Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage. Childs Nerv Syst. 2013; 30(3):411-8. DOI: 10.1007/s00381-013-2243-0. View

10.

Sanapo L, Whitehead M, Bulas D, Ahmadzia H, Pesacreta L, Chang T . Fetal intracranial hemorrhage: role of fetal MRI. Prenat Diagn. 2017; 37(8):827-836. DOI: 10.1002/pd.5096. View

11.

Elchalal U, Yagel S, Gomori J, Porat S, Beni-Adani L, Yanai N . Fetal intracranial hemorrhage (fetal stroke): does grade matter?. Ultrasound Obstet Gynecol. 2005; 26(3):233-43. DOI: 10.1002/uog.1969. View

12.

Oglak S, Bademkiran M, Obut M . Predictor variables in the success of slow-release dinoprostone used for cervical ripening in intrauterine growth restriction pregnancies. J Gynecol Obstet Hum Reprod. 2020; 49(6):101739. DOI: 10.1016/j.jogoh.2020.101739. View

13.

Huang Y, Chen W, Tseng J, Ho E, Chou M . Fetal intracranial hemorrhage (fetal stroke): report of four antenatally diagnosed cases and review of the literature. Taiwan J Obstet Gynecol. 2007; 45(2):135-41. DOI: 10.1016/S1028-4559(09)60211-4. View

14.

Carletti A, Colleoni G, Perolo A, Simonazzi G, Ghi T, Rizzo N . Prenatal diagnosis of cerebral lesions acquired in utero and with a late appearance. Prenat Diagn. 2009; 29(4):389-95. DOI: 10.1002/pd.2244. View

15.

Putbrese B, Kennedy A . Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI?. Br J Radiol. 2016; 90(1070):20160253. PMC: 5685119. DOI: 10.1259/bjr.20160253. View

16.

Strigini F, Cioni G, Canapicchi R, Nardini V, Capriello P, Carmignani A . Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?. Ultrasound Obstet Gynecol. 2002; 18(4):335-42. DOI: 10.1046/j.0960-7692.2001.00486.x. View

17.

Qi W, Luo J, Li Z, Zhang Q, Liu Z, Liao Q . Clinical analysis of eight cases of fetal intracranial hemorrhage in pregnancy. J Matern Fetal Neonatal Med. 2019; 34(16):2609-2615. DOI: 10.1080/14767058.2019.1670791. View

18.

Malinger G, Paladini D, Haratz K, Monteagudo A, Pilu G, Timor-Tritsch I . ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 1: performance of screening examination and indications for targeted neurosonography. Ultrasound Obstet Gynecol. 2020; 56(3):476-484. DOI: 10.1002/uog.22145. View