Neonatal Periventricular Leukomalacia Preceded by Fetal Periventricular Echodensity

Abstract

Objective: The purpose of this prospective study is to verify whether fetal periventricular echodensity (PVE) precedes neonatal periventricular leukomalacia (PVL). Methods: Fetal brains were studied with transvaginal scan in 63 high-risk fetuses from 17 to 32 weeks of pregnancy, PVE echogenicity was quantified with ultrasonic histogram, and neonatal brains and clinical courses were studied after birth. Results: No fetal cystic PVL was found, instead, fetal PVE was detected in 42 fetuses. The quantified echogenicity value was higher in PVE than in normal brain. Four cases developed neonatal PVL among 28 preterm and 1 among 14 term births. Neonatal PVL developed in the 23 cases of persistent fetal PVE, whereas no neonatal PVL was found when fetal PVE was negative or disappeared. Cord compression signs were common in PVL cases. Conclusion: Neonatal PVL was preceded by antepartum persistent fetal PVE in the present study.

Possible treatment of fetal distress without caesarean delivery

“…In preterm labor, periventricular echo density (PVE), which is hyperechogenesity around the ventricle, preceded neonatal PVL and CP, when the PVE lasted until preterm birth, but no brain damage was noted in the full term delivery [19]. Therefore, normal infant is expected without hypoxia if preterm labor is suppressed by tocolysis until full term delivery.…”

Prenatal diagnosis of cystic periventricular leukomalacia in a full term fetus

“…Another mechanism is infection-infl ammation, which seems to be an important risk factor for brain injury, especially in term infants. Other risk factors for neonatal PVL Heui Jin Joo, et al Prenatal diagnosis of full term PVL mentioned in the literature are premature rupture of membrane, preterm birth, multiple pregnancy, intrauterine growth retardation, reduced amniotic fl uid, cord compression, and low Apgar scores [4,5]. The fetal brain has restorative powers, in which intrauterine damage to the brain can be a brief incident where regrowth of the brain tissue occurs; consequently, the neonatal outcome would be normal, and PVE would disappear.…”

“…The baby in this case was diagnosed with cystic PVL with periventricular echogenic shadows or echodensities. A study by Yamamoto et al [4] states that there is a relationship between the gestational age at delivery and the persistence of fetal PVE, which eventually leads to neonatal PVL. White matter damage causes accumulation of astroglia, which may cause high echogenicity on ultrasound examination.…”

Gray Level Histogram Width Tissue Characterization

“…Also, no PVE developed in full-term births' neonates. The GLHW of fetal PVE was 36±5 % which was significantly larger than 23±5 % of normal fetal brain GLHW [8], thus, GLHW is useful to diagnose fetal and neonatal brain PVE in the prevention of neonatal PVL and CP, namely, the PVE ultrasonically detected immediately after a preterm birth will be effectively treated administrating Ovarian tumor GLHW values, which was larger in malignancy than benign one, while coefficient of variation (CV) was larger in benign one than malignancy. There was significant difference between GLHW values of benign and malignant ovarian tumors [4,6].…”

“…Yamamoto et al [8] studied fetal brain in preterm pregnancy detecting periventricular echodensity (PVE) (Figure 5), of which 18 % (corresponding 0.2 % of all births) preceded neonatal periventricular leukomalacia (PVL) followed by cerebral palsy (CP), if the PVE lasted until preterm birth, while there was no neonatal PVL when the PVE disappeared before birth. Also, no PVE developed in full-term births' neonates.…”