Ghi T, Simonazzi G, Perolo A, Savelli L, Sandri F, Bernardi B, Santini D, Bovicelli L, Pilu G
Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
Ultrasound Obstet Gynecol. 2003 Aug;22(2):121-30. doi: 10.1002/uog.191.
Prenatal diagnosis of intracranial hemorrhage (ICH) has been widely reported. Hemorrhages may occur either within the cerebral ventricles, subdural space or infratentorial fossa. The aim of this study was to determine the sonographic criteria for the diagnosis of fetal ICH, the role of in utero magnetic resonance imaging (MRI) and the outcome of this condition.
The archives of our ultrasound laboratory and the literature were searched for all cases of antenatally diagnosed ICH. A grading system was used to classify the intraventricular lesions as suggested in postnatal sonographic studies.
Adding our series of 16 fetuses to the 93 cases identified in the literature, a group of 109 fetal ICHs was obtained: 89 were intracerebral (79 intraventricular and 10 infratentorial) and 20 were subdural hemorrhages. Intraventricular lesions were mostly classified as severe (32 each for Grades III and IV). In 27 cases antenatal MRI was performed additionally to ultrasound and confirmed the sonographic findings. Of the entire group, 65 infants (59%) were reported to be alive 1 month after birth (51 intraventricular hemorrhages, three infratentorial hemorrhages, 11 subdural hematomas). At 12 months, of the 48 infants whose follow-up was available, 25 or 52% were judged neurologically normal (17/36 or 47% among the intraventricular hemorrhages, 6/9 or 66% among the hematomas, and 2/3 or 66% among the infratentorial hemorrhages).
Fetal ICH may be accurately identified and categorized by antenatal sonography. The outcome is usually poor, especially for those fetuses affected by higher-grade intraventricular hemorrhages.
颅内出血（ICH）的产前诊断已有广泛报道。出血可发生在脑室、硬膜下间隙或幕下窝内。本研究的目的是确定胎儿ICH的超声诊断标准、宫内磁共振成像（MRI）的作用以及这种情况的预后。
在我们超声实验室的档案和文献中搜索所有产前诊断为ICH的病例。采用一种分级系统对脑室内病变进行分类，分类方法参考了产后超声研究中的建议。
将我们的16例胎儿病例与文献中确定的93例病例相加，得到一组109例胎儿ICH：89例为脑内出血（79例脑室内出血和10例幕下出血），20例为硬膜下出血。脑室内病变大多被分类为重度（III级和IV级各32例）。27例病例在超声检查之外还进行了产前MRI检查，结果证实了超声检查结果。在整个研究组中，据报告65例婴儿（59%）出生后1个月存活（51例脑室内出血、3例幕下出血、11例硬膜下血肿）。在12个月时，在有随访信息的48例婴儿中，25例（52%）被判定神经功能正常（脑室内出血患儿中17/36例，即47%；血肿患儿中6/9例，即66%；幕下出血患儿中2/3例，即66%）。
产前超声检查可准确识别胎儿ICH并进行分类。预后通常较差，尤其是对于那些受较高级别脑室内出血影响的胎儿。
