Kutuk Mehmet Serdar, Yikilmaz Ali, Ozgun Mahmut Tuncay, Dolanbay Mehmet, Canpolat Mehmet, Uludag Semih, Uysal Gulsum, Tas Mustafa, Musa Karakukcu
Faculty of Medicine, Department of Obstetrics and Gynecology, Gevher Nesibe Hospital, Erciyes University, 38039, Kayseri, Turkey.
Childs Nerv Syst. 2014 Mar;30(3):411-8. doi: 10.1007/s00381-013-2243-0. Epub 2013 Aug 2.
The aim of this study was to present our experience with six cases of fetal intracranial hemorrhage (ICH) in terms of prenatal diagnostic features, and postnatal outcome.
The database of prenatal diagnosis unit was searched for antenatally diagnosed ICH cases. Maternal characteristics, ultrasound (US), and magnetic resonance imaging (MRI) findings, clinical course, and postnatal outcome were noted.
We evaluated six consecutive cases of fetal ICH. One case was terminated at 24 weeks, and remaining five cases were delivered between 34 and 38 weeks. Five cases (5/6) had intraventricular, and one (1/6) had intraparenchymal hemorrhage. Hemorrhages were right sided in five cases (5/6), left sided in one case (1/6). Dilated and echogenic ventricular wall were the common US findings. No predisposing factor was detected in four of the cases, and intrauterine growth restriction was an underlying factor in two fetuses. Intrauterine progression of the hydrocephaly, and parenchymal thinning was seen in four cases (4/6). In three of four cases (3/4) with progressive grade 3-4 hemorrhage and hydrocephaly, postnatal outcome were dismal, and one case had mild neurological impairment at three months. In one case which had non-progressive mild ventriculomegaly, the lesion regressed after 4 weeks, and had normal short-term outcome
Fetal ICH can be accurately identified and categorized by antenatal sonography, and fetal MRI. Although intrauterine regression or normal short-term postnatal outcome is possible, the outcome is usually poor for fetuses with high grade and/or progressive lesions. Therefore, further studies assessing long-term postnatal outcome are needed.
本研究旨在介绍我们在6例胎儿颅内出血（ICH）病例中的产前诊断特征及产后结局方面的经验。
在产前诊断科室的数据库中搜索产前诊断为ICH的病例。记录产妇特征、超声（US）和磁共振成像（MRI）检查结果、临床过程及产后结局。
我们评估了6例连续的胎儿ICH病例。1例在24周时终止妊娠，其余5例在34至38周之间分娩。5例（5/6）为脑室内出血，1例（1/6）为脑实质内出血。5例（5/6）出血位于右侧，1例（1/6）位于左侧。脑室壁扩张和回声增强是常见的超声表现。4例未检测到诱发因素，2例胎儿存在潜在的宫内生长受限因素。4例（4/6）出现脑积水和脑实质变薄的宫内进展情况。在4例（3/4）出现3-4级进行性出血和脑积水的病例中，产后结局不佳，1例在3个月时存在轻度神经功能障碍。1例出现非进行性轻度脑室扩大的病例，病变在4周后消退，短期结局正常。
胎儿ICH可通过产前超声和胎儿MRI准确识别和分类。尽管宫内病变可能消退或产后短期结局正常，但对于高级别和/或进行性病变的胎儿，结局通常较差。因此，需要进一步研究评估产后长期结局。
