Fetal Intraventricular Bleeding Possibly due to Maternal Vitamin K Deficiency

Abstract

We report a rare case of fetal intraventricular bleeding possibly due to maternal vitamin K deficiency. A 20-year-old woman was admitted to our hospital due to impending premature delivery and loss of dietary intake at 28 weeks of gestation. Her blood examination showed metabolic alkalosis, prolonged prothrombin time, and extremely high level of plasma des-gamma-carboxyprothrombin (protein induced by vitamin K absence, PIVKA-II). Intraventricular hemorrhage was demonstrated by ultrasonography 6 days after admission. She delivered a 2,288-gram girl infant at 40 weeks of gestation. Cranial computerized tomography and magnetic resonance images obtained postnatally demonstrated a reduced cerebral parenchyma adjacent to the interior side of the right lateral ventricle and the deficit of left cerebellum. The infant’s head control was insufficient and central impaired hearing was noted at 6 months of life.

Prevalence of subclinical vitamin K deficiency in Thai newborns: relationship to maternal phylloquinone intakes and delivery risk

“…For this reason it is not feasible to accurately measure K 1 concentrations in cord plasma. The importance of maintaining adequate vitamin K intakes during pregnancy is illustrated by case reports showing that maternal dietary depletion can lead to fetal cerebral haemorrhage29–31 or at early stages to fetal skeletal abnormalities, probably due to inactivity of the vitamin K-dependent matrix Gla protein 32 33. In one of these cases of fetal subdural haematoma, the mother's PIVKA-II was only slightly elevated showing that fetal VKDB can develop even when the maternal deficiency is mild 31…”

Fetal intracranial hemorrhage due to maternal subclinical vitamin K deficiency associated with long‐term eating disorder

“…Eating disorders and vomiting in pregnant women are commonly associated with hyperemesis, but they usually do not develop to fetal ICH. In previous reports of vitamin K deficiency caused fetal ICH, maternal eating disorder or reduced intestinal absorption of vitamin K lasted for more than 3 weeks. Pregnant women with eating disorders more than 3 weeks could develop fetal ICH due to maternal subclinical vitamin K deficiency.…”

“…Moreover, six pregnant women with fetal ICH due to maternal vitamin K deficiency have been reported in the literature (Table ) . The causes of vitamin K deficiency were Crohn disease (one patient) and eating disorders (seven patients; after bariatric surgery in one, hyperemesis gravidarum in two, magnesium sulfate in one, esophageal hiatal hernia in one, anxiety disorders in one, and somatoform disorders in one).…”

“…Fetal ICH often results in neurologic impairment even if fetal ICH improved before birth; thus, prevention of fetal ICH is necessary. Fetal ICH may be prevented through vitamin K supplementation to pregnant women, but its interval and dosage have not been established.…”

“…In Japan, pregnant women taking drugs inhibiting vitamin K metabolism or intestinal absorption are recommended to take vitamin K from 36 gestational weeks until labor onset. Vitamin K deficiency can develop to fetal ICH before 36 gestational weeks . Fetal ICH is rare; however, it is life threatening and persistent neurological damage is frequent in survivors .…”