CLINICAL-SIGNIFICANCE OF FETAL INTRACRANIAL HEMORRHAGE

OBJECTIVE: We reviewed our experience with six consecutive cases of fe tal intracranial hemorrhage and the cases published in the English lit erature in an attempt to devise an original prognostic scoring system for antenatal intracranial hemorrhage. STUDY DESIGN: The series includ ed the cases of fetal intracranial hemorrhage detected at our institut ion between 1992 and 1994 by transabdominal ultrasonography. In additi on, we performed an English literature search (Medline computer search , National Library of Medicine) of all reported cases of a prenatal di agnosis of intracranial hemorrhage. The prenatal ultrasonographic find ings were correlated with the clinical outcome, which was divided into (1) normal outcome or mild neurologic sequelae and (2) poor outcome ( severe neurologic impairment and fetal or neonatal death). RESULTS: Si x cases of intracranial hemorrhage were detected in a population of 66 41 pregnancies (0.9/1000) at our institution. Parenchymal involvement was present in three cases. Review of the English literature revealed 35 additional cases with prenatal ultrasonographic findings and postna tal follow-up. The total cases (n = 41) were divided into three groups : (1) isolated intraventricular hemorrhage (n = 20), (2) parenchymal h emorrhage (n = 13), and (3) subdural or subarachnoid hemorrhage (n = 8 ). Overall, poor outcome was present in 68% of cases, including 45% (9 /20) of intraventricular hemorrhage, 92% (12/13) of parenchymal hemorr hage, and 88% (7/8) of subdural or subarachnoid hemorrhage. The hetero geneity of the intraventricular hemorrhage group in both severity of a ntenatal findings and outcome prompted us to devise a prognostic scori ng system based on prenatal ultrasonographic lesions, grouping cohorts with similar outcomes. Outcome was favorable in 100% (5/5) of grade 1 intraventricular hemorrhage cases, in 50% (6/12) of grade 2 cases, an d in 0% (0/3) of grade 3 cases.CONCLUSIONS: Fetal intracranial hemorrh age can be classified on the basis of the anatomic location of the int racranial bleeding. The prognosis is poor in nearly 90% of parenchymal and subdural hemorrhages, whereas it is better in the subgroup with i ntraventricular hemorrhage. The prognostic scoring system we propose f or intraventricular hemorrhage may assist the physician in providing p atients with prognostic information.