Prenatal sonographic diagnosis of intracranial haemorrhage: Report of a case with a sinusoidal fetal heart rate tracing, and review of the literature

Abstract

The sinusoidal fetal heart rate pattern has been described in association with severe fetal anaemia, with fetal hypoxaemia, and with the administration of parenteral narcotics. Here, we report a case of decreased fetal movement in which a sinusoidal tracing was recorded. The sonographic diagnosis of a massive fetal intracranial haemorrhage was made. A non-interventive approach was taken and the fetus died soon after in utero. We review 28 previous cases in which the prenatal sonographic diagnosis of fetal intracranial haemorrhage was made, including the underlying maternal and fetal factors and neonatal outcomes. We propose that the sinusoidal tracing in this case was due to the intracranial bleed and suggest that fetal intracranial haemorrhage be considered in the sonographic evaluation of the fetus with a sinusoidal pattern.

Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?

“…This association is not uncommon [4][5][6][7][8][9][10] , and it is usually explained on the basis of hypoxia leading to both IUGR and intracerebral circulatory changes with secondary hemorrhage 4 . However, it might also be hypothesized that 33 .…”

“…As many of these cases were associated with placental abruption 2,3 or intrauterine growth restriction (IUGR) [4][5][6][7][8][9][10] , the same hypoxic / asphyctic pathogenesis that is often relevant in newborns was hypothesized to be so also in fetuses. In other cases, fetal intracranial hemorrhage has been linked to fetal thrombocytopenia 7,11 or coagulation disorders 12 -14 .…”

“…Minor maternal trauma resulting from, for example, abdominal massage has also been related to intracranial, and especially subdural, hemorrhage 16,17 . Furthermore, fetal intracranial hemorrhage has also been described in association with a variety of maternal pathologies, such as pancreatitis 18 , cholecystectomy 5 , seizures 19 and cytomegalovirus infection 20 and has also been associated with amniocentesis 21 . However, many cases remain unexplained 10 .…”

Fetal Germinal Matrix and Intraventricular Hemorrhage

“…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].…”

“…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]. In our case 1 of twins, only the one of the twins developed GMIVH, suggesting that systemic disorders such as maternal coagulopathies are not considered a significant factor, although fetal ‘focal’ coagulopathy could not be ruled out.…”