VP26.03: Early severe fetal intracranial hemorrhage: a diagnostic challenge

Abstract

Virtual poster abstractsrarity and diverse presentation. The aim of this systematic review and meta-analysis was to investigate the perinatal outcomes of fetuses with ICH. Methods: Medline, Embase, Clinicaltrials.gov and Cochrane Library databases were searched. We included studies reporting the outcomes of fetuses with ICH. The primary outcome was perinatal death (PND), i.e. the sum of intra-uterine (IUD) and neonatal death (NND). The secondary outcomes were IUD, NND, TOP, need for surgery/shunting at birth, cerebral palsy, neurodevelopmental delay, and intact survival. Outcomes were explored in the whole population and for intra and extra-axial ICH. Meta-analyses of proportions were used to combine data, we reported pooled proportion and their 95% confidence intervals (CI). Results: 16 studies (193 fetuses) were included. PND occurred in 14.6% (95%CI 7.3-24.0), of fetuses with ICH. Of those liveborn, 27.6% (95%CI 12.5-45.9) required a shunt after birth and 32.0% (95%CI 22.2-42.6) had cerebral palsy. 16.7% of children had mild and 31.1% experienced severe neurodevelopmental delay. A normal outcome was reported in 53.6% fetuses. Looking at location, PND occurred in 13.3% (95%CI 5.7-23.4) of fetuses with intra-axial and in 26.7% ) with extra-axial bleeding. In cases with intra-axial hemorrhage, 24.7% required a shunt after birth and 27.1% had cerebral palsy. Mild and severe neurodevelopmental delay were observed in 15% (95%CI 6.9-25.6) and 32.3% 3) of cases, respectively, while 51.9% experienced a normal outcome. Robust evidence for fetuses with extra-axial hemorrhage could not be extrapolated due to the small number of cases. Conclusions: Fetuses with ICH are at high risk of perinatal morality and impaired neurodevelopmental outcome. Postnatal shunt placement was performed in 28% and cerebral palsy was diagnosed in approximately one third of these infants.