Fetal intracranial hemorrhage may occur either within the cerebral ventricles, subdural space or infratentorial fossa.
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Pathology
Hemorrhages can occur in a number of situations:
- mechanical trauma, e.g. maternal abdominal blunt or birth trauma
- severe fetal hypoxia
- background fetal thrombocytopenia, e.g. congenital factor X and factor V deficiencies
- maternal thrombocytopenia
- alloimmune and idiopathic thrombocytopenia
- von Willebrand disease
- specific medications, e.g. warfarin, illicit drug (cocaine) abuse
- hemorrhage into a fetal intracranial tumor
- twin-twin transfusion 5
- demise of a co-twin 5
Radiographic feautures
Antenatal ultrasound
The sonographic appearance of fetal intracranial hemorrhage is extremely variable, depending on its location and age of the hemorrhage. A massive intraparenchymal hemorrhage can sometimes be seen as an irregular hyperechoic mass. As the hemorrhage matures, porencephalic cyst formation or fetal intracranial calcification may be seen.
Treatment and prognosis
The outcome is usually poor particularly with parenchymal and subdural hemorrhage, whereas it is better in the subgroup with intraventricular hemorrhage.
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