Prenatal Detection and Outcome of Intracerebral Hemorrhage

Abstract

Background:

Fetal intracranial hemorrhage occurs in about 1/10000 pregnancies and can pose neurological impairments. Intraventricular hemorrhage is the most frequent subtype. Prenatal assessment with neurosonography and MRI are essential to counsel the parents. We aimed to apply a new proposed classification for IVH on MRI and compare it with the classification performed on ultrasound.

Methods:

This single-center retrospective study included all consecutive fetuses with ICH between 2005-2023. Prenatal neurosonogram and fetal MRI, maternal characteristics, etiologic factors, pregnancy outcome and postnatal neurological outcomes were recorded. A recent MRI classification was applied.

Results:

We identified 48 fetal ICH cases. Ventriculomegaly was in 77 %, the reason for referral. 91.7 % underwent subsequentially fetal MRI investigation; revealing abnormalities in 16.3 %, mainly polymicrogyria or cortical malformations. An etiology could be identified in 18 of 48 cases (37.5%). MRI findings were classified according to a recently proposed classification system. Thirty-four patients were included with a mean GA of 31 weeks (+/-3.6 weeks). There was parenchymal involvement in 61.8%. The parenchymal involvement consisted of porencephaly in 50% and having irregular ventricular borders in 23.5%. MRI detected hemosiderin deposits in 67.6%. The central sulcus was involved in 71.4% with parenchymal malformations.Neurological follow-up data were available for 17/22 cases. Neurodevelopmental delay was reported in 7 cases, four children were developing normally, and six children were less than one year old.

Discussion:

In our study, 14 cases were graded with parenchymal involvement on NSG, yet on MRI 17 cases illustrated parenchymal involvement with porencephalic cysts. This new MRI classification provided more detailed information on the extent of parenchymal involvement.

Conclusion:

This retrospective case series reports on the perinatal mortality and postnatal morbidity with ICH. Diagnosis of IVH is made in the late second or third trimester. Ventriculomegaly was the most common US finding. Prenatal MRI adds additional information to the initial ultrasound in 16.3 % and is likely to be beneficial for parental counseling. An etiology for IVH was found in 37.5%. We report no loss in Grades I and II.