Fetal brain intraventricular hemorrhage

Discussion:

Findings are suggestive of intraventricular hemorrhage with extension to the adjacent brain parenchyma and secondary hydrocephalic changes ( grade IV germinal matrix hemorrhage). 

Germinal matrix usually disappears after 32 weeks of gestations and hence persists in premature children. It has weak blood vessels which in response to ischemia rupture leading to hemorrhage. The hemorrhage may be localized at subependymal region (Grade I) or extends to the lateral ventricles without hyrocephalus (Grade II) or with hydrocephalus (Grade III) or extends to brain parenchyma (Grade IV).

In this case, during seemingly uneventful pregnancy, fetal GMIVH was suspected to occur at approximately 30-33 weeks of gestation, with the absence of any known factor predisposing to fetal hemorrhage. Prenatal MRI is a must in cases of hemorrhage to predict neurodevelopmental prognosis of the fetal brain. 

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