Abstract
Background
The prenatal and early postnatal outcomes of fetal intracranial hemorrhage (ICH) prenatally
diagnosed by fetal magnetic resonance imaging (MRI) have not been well described.
Methods
A retrospective study of cases with fetal ICH diagnosed by fetal MRI at Children's
National Hospital, Washington, DC, from 2012 to 2020 was conducted. Maternal characteristics,
prenatal imaging, pregnancy outcome, and child developmental outcomes were recorded.
Abnormal outcomes were categorized as mild for required physical/occupational therapy
without other delays, moderate for intermediate multidomain developmental delays,
and severe if nonambulatory, nonverbal, or intellectual disability.
Results
Fifty-seven cases with fetal ICH were included. The mean (S.D.) maternal age was 31.1
(6.9) years, gestational age at fetal evaluation was 28.1 (5.3) weeks, and gestational
age at birth was 38.2 (1.3) weeks. Pregnancy outcomes were 75% (n = 43) live birth,
14% (n = 8) termination of pregnancy, and 11% (n = 6) intrauterine demise (IUD). Live
births decreased from 90% to 33% and IUD increased 10% to 22% when comparing unilateral
intraventricular hemorrhage with more extensive hemorrhages. Among the 37 live-born
infants with clinical follow-up to age 1.8 (1.6) years, neurodevelopmental outcome
was normal in 57%, mildly abnormal in 24%, moderately abnormal in 14%, and severely
abnormal in 5%. In five cases, an etiology was identified: two had placental pathologies,
two had genetic findings (fetal neonatal alloimmune thrombocytopenia and COL4A1 mutation), and one had congenital cytomegalovirus infection.
Conclusion
Perinatal and early child outcomes following fetal ICH have a wide spectrum of outcomes.
Fetal MRI description of ICH location may aid in pregnancy and postnatal outcome prediction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Pediatric NeurologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fetal intracranial hemorrhage (fetal stroke): does grade matter?.Ultrasound Obstet Gynecol. 2005; 26: 233-243
- Prenatal diagnosis and postnatal outcome of fetal intracranial hemorrhage.Childs Nerv Syst. 2014; 30: 411-418
- Cerebrovascular disorders in the prenatal period.J Child Neurol. 2008; 23: 1260-1266
- Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature.Ultrasound Obstet Gynecol. 2003; 22: 121-130
- Antepartum fetal intracranial hemorrhage, predisposing factors and prenatal sonography: a review.Am J Perinatol. 1998; 15: 431-441
- Fetal intracranial hemorrhage: sonographic criteria and merits of prenatal diagnosis.J Matern Fetal Neonatal Med. 2016; 9: 1-21
- Prenatal evaluation of intracranial hemorrhage on fetal MRI: a retrospective review.AJNR Am J Neuroradiol. 2021; 42: 2222-2228
- Fetal intracranial hemorrhage: role of fetal MRI.Prenat Diagn. 2017; 37: 827-836
- Fetal intracranial haemorrhage: clinical significance of in utero ultrasonographic diagnosis.Br J Obstet Gynaecol. 1993; 100: 995-999
- Fetal magnetic resonance imaging (MRI) of ischemic brain injury.Prenat Diagn. 2001; 21: 729-736
- Role of foetal MRI in the evaluation of ischaemic-haemorrhagic lesions of the foetal brain.J Perinat Med. 2012; 40: 419-426
- Utility of fetal MRI for workup of fetal central nervous system anomalies in an Australian maternal-fetal medicine cohort.Aust N Z J Obstet Gynaecol. 2016; 56: 267-273
- Different information by MRI compare to ultrasound in fetal intracranial space occupying lesions.Childs Nerv Syst. 2017; 33: 2129-2136
- Additional value of fetal magnetic resonance imaging in the prenatal diagnosis of central nervous system anomalies: a systematic review of the literature.Ultrasound Obstet Gynecol. 2014; 44: 388-393
- Fetal intracranial hemorrhage. Prenatal diagnosis and postnatal outcomes.J Matern Fetal Neonatal Med. 2019; 32: 21-30
- Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Fetal MRI of the central nervous system: State-of-the-art.Eur J Radiol. 2017; 93: 273-283
- MR imaging of fetal cerebral anomalies.Pediatr Radiol. 1998; 28: 212-222
- Fetal cerebellar disorders.Handb Clin Neurol. 2018; 155: 3-23
- Highlights on MRI of the fetal body.Radiol Med. 2018; 123: 271-285
- Fetal MRI of CNS abnormalities.Clin Radiol. 2020; 75: 640.e1-640.e11
- Fetal ventriculomegaly: diagnosis, treatment, and future directions.Childs Nerv Syst. 2017; 33: 1113-1123
- Fetal intracerebral hemorrhage and cataract: think COL4A1.J Perinatol. 2014; 34: 75-77
- Mutations in Col4a1 cause perinatal cerebral hemorrhage and porencephaly.Science. 2005; 308: 1167-1171
- Prenatal clinical manifestations in individuals with COL4A1/2 variants.J Med Genet. 2021; 58: 505-513
- Neurologic phenotypes associated with COL4A1/2 mutations: Expanding the spectrum of disease [published correction appears in Neurology. 2020 Feb 18;94(7):332].Neurology. 2018; 91: e2078-e2088
- Indications for submission and macroscopic examination of the placenta.APMIS. 2018; 126: 544-550
- Genetic testing in children.Indian Pediatr. 2013; 50: 823-827
Article info
Publication history
Published online: January 03, 2023
Accepted:
December 25,
2022
Received:
April 18,
2022
Footnotes
Declaration of interest: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
