Eldad Katorza, Ya'ara Gutman, Simon Lassman, Omer Bar-Yosef
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Gertner Institute for Epidemiology & Health Policy Research, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel; Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel; Arrow Program for Medical Research Education, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Radiol. 2024 Apr;173:111380. doi: 10.1016/j.ejrad.2024.111380. Epub 2024 Feb 17.
Fetal intracranial hemorrhage is rarely identified in prenatal imaging. When identified, sparse data regarding neurodevelopmental outcomes worsens prenatal dilemmas. This MRI-based study aimed to assess prenatal characteristics and neurodevelopmental outcomes of fetal intracranial hemorrhage.
A historical cohort study which identified fetal intracranial hemorrhage in 22 individual fetal MRI scans, as part of the assessment of abnormal prenatal sonographic findings. Severity was graded by the grading system commonly used in neonates, with modifications. Prenatal data was collected. Neurodevelopmental outcome was assessed clinically by Vineland-II Adaptive Behavior Scales.
Eight fetuses had intraventricular hemorrhage grade I-II, twelve had intraventricular hemorrhage grade III-IV, and two had infratentorial hemorrhage. The most prevalent risk factors were maternal chronic diseases and chronic use of medications. There was male predominance. Pregnancy was terminated in eleven cases. No surviving child who participated in the Vineland assessment had a grade IV hemorrhage. Vineland scores were normal in 9/11 children and moderately low in 2/11. The mean composite score of the cohort was not different from the mean score expected for age. Clinically, one child had hypotonia.
Prognosis for fetuses with ICH without parenchymal involvement is potentially more favorable than expected from the intraventricular hemorrhage grading-scale adopted from the preterm neonates. Parenchymal involvement may predict a worse outcome, but it is not the sole predicting feature. This information may be valuable during prenatal counseling.
胎儿颅内出血在产前影像学检查中很少被发现。一旦被发现，关于神经发育结局的稀疏数据会使产前决策更加困难。这项基于磁共振成像（MRI）的研究旨在评估胎儿颅内出血的产前特征和神经发育结局。
一项历史性队列研究，在22例胎儿MRI扫描中识别出胎儿颅内出血，作为对异常产前超声检查结果评估的一部分。严重程度采用新生儿常用的分级系统进行分级，并做了修改。收集产前数据。通过文兰适应性行为量表第二版（Vineland-II Adaptive Behavior Scales）对神经发育结局进行临床评估。
8例胎儿为Ⅰ-Ⅱ级脑室内出血，12例为Ⅲ-Ⅳ级脑室内出血，2例为幕下出血。最常见的危险因素是母亲的慢性疾病和长期用药。男性居多。11例妊娠终止。参与文兰评估的存活儿童中，没有Ⅳ级出血的情况。11名儿童中文兰评分正常的有9例，中度偏低的有2例。该队列的平均综合评分与预期年龄的平均评分无差异。临床上，1名儿童有肌张力减退。
对于没有实质受累的颅内出血胎儿，其预后可能比从早产儿采用的脑室内出血分级量表预期的更有利。实质受累可能预示着更差的结局，但它不是唯一的预测特征。这些信息在产前咨询中可能很有价值。
