Sherer D M, Anyaegbunam A, Onyeije C
The Department of Obstetrics and Gynecology & Women's Health, Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, New York 10461, USA.
Am J Perinatol. 1998 Jul;15(7):431-41. doi: 10.1055/s-2007-993971.
Our objective was to review current literature pertaining to antepartum fetal intracranial hemorrhage. To this goal we selected all manuscripts published in the English language regarding this topic obtained from a MEDLINE search for 1966 through January 1998. Additional sources were identified through cross-referencing. Antenatal fetal intracranial hemorrhage may occur spontaneously, or occur in association with various maternal or fetal conditions. Predisposing maternal conditions at risk for this occurrence include alloimmune and idiopathic thrombocytopenia, von Willebrand's disease, specific medications (warfarin) or illicit drug (cocaine) abuse, seizures, severe abdominal trauma inflicting subsequent fetal injury, amniocentesis, cholestasis of pregnancy and febrile disease. Predisposing fetal conditions include congenital factor-X and factor-V deficiencies, hemorrhage into various congenital tumors, twin-twin transfusion, demise of a co-twin, or fetomaternal hemorrhage. Currently, antepartum fetal intracranial hemorrhage may be diagnosed by imaging techniques including ultrasonography and less frequently, magnetic resonance imaging. Early real-time sonographic signs of intracranial hemorrhage consist of irregular echogenic patterns representing the associated hematoma that may clearly distort normal intracranial structures. Recent reports have suggested Doppler flow velocimetry and color Doppler imaging as additional tools in detecting fetal intracranial hemorrhage. Various types of antenatal fetal intracranial hemorrhages that have been visualized sonographically include intraventricular, periventricular, subependymal, parenchymal, subdural, and intracerebellar events. Active hemorrhages may be associated with fetal distress manifested by fetal heart rate changes. Infrequently, antenatal ultrasonographic depiction of intracranial hemorrhage may precede devastating sequelae such as hydrocephalus, hydranencephaly, porencephaly, or microcephaly. Due to the significant associated neonatal neurological impairment and potential medicolegal implications of antepartum fetal intracranial hemorrhage, it follows that obstetricians and sonographers should be familiar with predisposing factors and typical diagnostic imaging findings of these events.
我们的目的是回顾当前与产前胎儿颅内出血相关的文献。为实现这一目标，我们选取了1966年至1998年1月通过MEDLINE搜索获得的所有关于该主题的英文手稿。通过交叉引用确定了其他来源。产前胎儿颅内出血可能自发发生，或与各种母体或胎儿状况相关。有发生这种情况风险的母体易感状况包括同种免疫和特发性血小板减少症、血管性血友病、特定药物（华法林）或非法药物（可卡因）滥用、癫痫发作、导致后续胎儿损伤的严重腹部创伤、羊膜腔穿刺术、妊娠胆汁淤积症和发热性疾病。胎儿易感状况包括先天性因子X和因子V缺乏、各种先天性肿瘤内出血、双胎输血、双胎之一死亡或胎儿-母体出血。目前，产前胎儿颅内出血可通过包括超声检查以及较少使用的磁共振成像在内的成像技术进行诊断。颅内出血的早期实时超声征象包括代表相关血肿的不规则回声模式，这可能会明显扭曲正常颅内结构。最近的报告表明，多普勒血流速度测定法和彩色多普勒成像可作为检测胎儿颅内出血的额外工具。超声检查可见的各种类型的产前胎儿颅内出血包括脑室内、脑室周围、室管膜下、实质内、硬膜下和小脑内出血。活动性出血可能与胎儿心率变化所表现的胎儿窘迫有关。产前超声检查对颅内出血的描述很少会先于诸如脑积水、积水性无脑畸形、孔洞脑或小头畸形等严重后遗症出现。由于产前胎儿颅内出血会导致严重的新生儿神经功能损害以及潜在的法医学问题，因此产科医生和超声检查人员应熟悉这些事件的易感因素和典型诊断成像表现。
