Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?

Objective The occurrence of fetal intracranial hemorrhage before labor bas been repeatedly observed. The aim of this stud), was to evaluate the sonographic appearance of fetal intracranial hemorrhage in relation to its location. Possible causative factors were also evaluated. Design 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-tip was initiated in the three surviving infants. Results 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 bad 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. Conclusions 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 tvas necessary to establish the hemorrhagic nature of isolated subependymal and extradural hemorrhage. The similarity (if 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.