OP13.05: Prenatal diagnosis of intracranial hemorrhage: report of a series of 17 cases

Although intracranial hemorrhage (ICH) is a common event in preterm infants, it may occur in utero as well. Prevalence is approximately 5:10000 pregnancies but only a few cases of prenatal diagnosis by either sonography (US) or magnetic resonance imaging (MRI) have been reported so far. The US appearance of fetal ICH is extremely variable depending upon the site, the severity and the time since it occurred. MRI plays an important role since it adds relevant information on the localization, the presence of ischemic areas and timing of the hemorrhagic event. Prenatally diagnosed ICH has a poor outcome, strongly related to the grade of the lesion. About 40% of fetuses die, and among the survivors, less than half appear neurodevelopmentally normal at short term follow-up. We present a series of 17 cases of ICH prenatally diagnosed, paying special attention to the US and MRI findings, and the clinical outcome. All cases with an antenatal diagnosis of ICH between 2005 and 2014 and available outcome were included. Most of the cases (82.3%) were identified during a third trimester routine scan at a median gestational age of 30 weeks (range 21-36). The ICH was classified as Grade 1 in 1 case, Grade 3 in 3 cases and Grade 4 in the remaining 13 cases. MRI was performed in 13 cases, being confirmative in all of them regarding grade and location. Six cases ended up with the termination of pregnancy, and 11 fetuses were born alive at term. These were followed up during a mean time of 18 months (range 6-96). Overall some grade of neurologic impairment was observed in 63,6% of the children (n:7;1G3,6G4), mainly mild to moderate motor sequelae. There were no postnatal deaths. Antenatal US allows an accurate diagnosis of fetal ICH. Most of the cases are identified during the third trimester and are of high grade. Conversely to that previously reported, postnatal survival is high but it entails the risk of adverse neurologic outcome in two thirds of the newborns. This information may help the physician in providing patients with prognostic information.