Strigini F A, Cioni G, Canapicchi R, Nardini V, Capriello P, Carmignani A
Division of Obstetrics and Gynecology, University of Pisa, Italy.
Ultrasound Obstet Gynecol. 2001 Oct;18(4):335-42. doi: 10.1046/j.0960-7692.2001.00486.x.
The occurrence of fetal intracranial hemorrhage before labor has been repeatedly observed. The aim of this study was to evaluate the sonographic appearance of fetal intracranial hemorrhage in relation to its location. Possible causative factors were also evaluated.
Five consecutive cases of fetal intracranial hemorrhage were identified at a single ultrasound unit between 1996 and 1999. In utero magnetic resonance imaging was also performed in four of these cases. Autopsy was performed after pregnancy termination or intrauterine fetal death (one case of each), and neurological follow-up was initiated in the three surviving infants.
Hydrocephaly was the predominant sonographic finding associated with intraventricular or subependymal hemorrhage; sonography provided the correct diagnosis in the former (two cases), whereas magnetic resonance imaging was necessary in the latter. Massive intraparenchymal hemorrhage was depicted as an irregular echoic mass, whereas extradural hemorrhage had a cystic appearance. History of minor maternal physical trauma without maternal or placental injury was elicited in all cases. Ultrasound examinations performed before or shortly after the trauma were available in all cases and showed normal fetal anatomy.
The sonographic appearance of fetal intracranial hemorrhage is variable, depending on its location. Even though sonography detected an intracranial anomaly in all cases, magnetic resonance imaging was necessary to establish the hemorrhagic nature of isolated subependymal and extradural hemorrhage. The similarity of histories involving minor maternal physical trauma in all cases, together with the absence of any known factor predisposing to fetal hemorrhage, may suggest that trauma is at least a contributing factor to the pathogenesis of fetal intracranial hemorrhage.
分娩前胎儿颅内出血的情况已被反复观察到。本研究的目的是评估胎儿颅内出血的超声表现与其位置的关系。还评估了可能的致病因素。
1996年至1999年期间，在一个超声科室连续发现了5例胎儿颅内出血病例。其中4例还进行了宫内磁共振成像检查。在终止妊娠或胎儿宫内死亡后进行了尸检（各1例），并对3名存活婴儿进行了神经学随访。
脑积水是与脑室内或室管膜下出血相关的主要超声表现；超声在前一种情况（2例）中提供了正确诊断，而在后一种情况中则需要磁共振成像。大量脑实质内出血表现为不规则回声团块，而硬膜外出血呈囊性外观。所有病例均有轻微母体身体创伤史，但无母体或胎盘损伤。所有病例在创伤前或创伤后不久均进行了超声检查，显示胎儿解剖结构正常。
胎儿颅内出血的超声表现因位置而异。尽管超声在所有病例中均检测到颅内异常，但对于孤立的室管膜下和硬膜外出血，需要磁共振成像来确定出血性质。所有病例中涉及轻微母体身体创伤的病史相似，且缺乏任何已知的胎儿出血易感因素，这可能表明创伤至少是胎儿颅内出血发病机制的一个促成因素。
