Active Crohn disease with maternal vitamin K deficiency and fetal subduralhematoma

BACKGROUND: Fetal subdural hematoma is a rare condition not considered a co mplication of Crohn disease in pregnancy. CASE: A young woman with a diagnosis of Crohn disease presented at 22 weeks ' gestation with diarrhea and melena for 3 weeks. Dietary and medicinal the rapies were begun. At 28 weeks' gestation, fetal ultrasonography showed an intracranial mass, which was seen to expand on serial ultrasound and magnet ic resonance imaging studies. A hematoma was suspected, and, although the m other had no overt hemorrhagic manifestations, maternal vitamin K deficienc y was diagnosed by enzyme immunoassay and corrected. After cesarean deliver y at 36 weeks' gestation, the newborn was normal, but magnetic resonance im aging showed a chronic subdural. hematoma. CONCLUSION: Maternal vitamin K deficiency in active Crohn disease might cau se fetal hemorrhage. Monitoring of vitamin K status during pregnancy with C rohn disease seems warranted. (Obstet Gynecol 2001;98:919-21. (C) 2001 by t he American College of Obstetricians and Gynecologists.).