Fetal Hydrocephalus Secondary to Intraventricular Hemorrhage Diagnosed by Ultrasonography and in utero Fast Magnetic Resonance Imaging

Abstract

Although fetal hydrocephalus is commonly detected by prenatal ultrasonographic examination, posthemorrhagic hydrocephalus has rarely been observed in the fetus. We report a case of hydrocephalus secondary to intraventricular hemorrhage (IVH) diagnosed by in utero magnetic resonance imaging (MRI) at 37 + 1 weeks of gestation. Ultrasonography revealed enlargement of the bilateral ventricles and an irregular mass measuring 20 × 12 × 10 mm in the right lateral ventricle. T1-weighted images with two-dimensional fast low-angle shot (2D-FLASH) and T2-weighted images with half-Fourier single-shot turbo spin echo (HASTE) demonstrated that an old hemorrhagic clot existed in the right lateral ventricle of the fetus. Hydrocephalus secondary to IVH was confirmed by postnatal MRI and ventriculoscopy. Fast MRI is especially useful for prenatal diagnosis of fetal brain abnormalities because it minimizes the artifact of fetal movement.

Fetal Germinal Matrix and Intraventricular Hemorrhage

“…Although GMIVH is a rare event in the fetus, several investigators have detected GMIVH in utero using prenatal US and MRI [9,10,11,12,13,14,15,16,17,18,19,20,21,22]. In several cases, umbilical cord or placental abnormalities [14], maternal pancreatitis [17], maternal pre-eclampsia [11], maternal seizures [20], possible sex-linked disorders [18] and severe thrombocytopenia [18] have been implicated as the initiating factors in the pathogenesis of GMIVH, but in most cases no underlying disease was identified [23, 24].…”

“…There are no established guidelines regarding the time and mode of delivery of the fetus with GMIVH [15]. Since progressive hydrocephalus during fetal life may result in irreversible brain damage [25], earlier termination of pregnancy may improve the neurological outcome of the fetus as long as the fetus is mature enough to survive and receive treatment for hydrocephalus [15].…”

“…Since progressive hydrocephalus during fetal life may result in irreversible brain damage [25], earlier termination of pregnancy may improve the neurological outcome of the fetus as long as the fetus is mature enough to survive and receive treatment for hydrocephalus [15]. Since elective C-section is usually chosen to avoid a hard labor due to a large head and associated intracranial hemorrhage [15], C-section was indicated in our cases 2–5. However, it is not clear whether this elective surgery was really essential or not, and in fact, some consider it to be overtreatment [15].…”

“…Since elective C-section is usually chosen to avoid a hard labor due to a large head and associated intracranial hemorrhage [15], C-section was indicated in our cases 2–5. However, it is not clear whether this elective surgery was really essential or not, and in fact, some consider it to be overtreatment [15]. …”

“…Transabdominal US, which is widely used for detecting fetal brain abnormalities, can demonstrate prenatal intracranial hemorrhage [9, 10, 17, 23], albeit with some limitations [23]. In addition to US, MRI has been used for the diagnosis of GMIVH and in the search of the etiology of IVH [4, 6, 7, 15, 24, 29, 30]. A case has been reported in which a prenatal ICH with IVH was missed on US but was correctly identified by fetal MRI [12].…”