Abstract：
OBJECTIVE: Fetal intracranial hemorrhage is rarely identified in prenatal imaging. When identified, sparse data regarding neurodevelopmental outcomes worsens prenatal dilemmas. This MRI-based study aimed to assess prenatal characteristics and neurodevelopmental outcomes of fetal intracranial hemorrhage.
METHODS: A historical cohort study which identified fetal intracranial hemorrhage in 22 individual fetal MRI scans, as part of the assessment of abnormal prenatal sonographic findings. Severity was graded by the grading system commonly used in neonates, with modifications. Prenatal data was collected. Neurodevelopmental outcome was assessed clinically by Vineland-II Adaptive Behavior Scales.
RESULTS: Eight fetuses had intraventricular hemorrhage grade I-II, twelve had intraventricular hemorrhage grade III-IV, and two had infratentorial hemorrhage. The most prevalent risk factors were maternal chronic diseases and chronic use of medications. There was male predominance. Pregnancy was terminated in eleven cases. No surviving child who participated in the Vineland assessment had a grade IV hemorrhage. Vineland scores were normal in 9/11 children and moderately low in 2/11. The mean composite score of the cohort was not different from the mean score expected for age. Clinically, one child had hypotonia.
CONCLUSIONS: Prognosis for fetuses with ICH without parenchymal involvement is potentially more favorable than expected from the intraventricular hemorrhage grading-scale adopted from the preterm neonates. Parenchymal involvement may predict a worse outcome, but it is not the sole predicting feature. This information may be valuable during prenatal counseling.
METHODS: A historical cohort study which identified fetal intracranial hemorrhage in 22 individual fetal MRI scans, as part of the assessment of abnormal prenatal sonographic findings. Severity was graded by the grading system commonly used in neonates, with modifications. Prenatal data was collected. Neurodevelopmental outcome was assessed clinically by Vineland-II Adaptive Behavior Scales.
RESULTS: Eight fetuses had intraventricular hemorrhage grade I-II, twelve had intraventricular hemorrhage grade III-IV, and two had infratentorial hemorrhage. The most prevalent risk factors were maternal chronic diseases and chronic use of medications. There was male predominance. Pregnancy was terminated in eleven cases. No surviving child who participated in the Vineland assessment had a grade IV hemorrhage. Vineland scores were normal in 9/11 children and moderately low in 2/11. The mean composite score of the cohort was not different from the mean score expected for age. Clinically, one child had hypotonia.
CONCLUSIONS: Prognosis for fetuses with ICH without parenchymal involvement is potentially more favorable than expected from the intraventricular hemorrhage grading-scale adopted from the preterm neonates. Parenchymal involvement may predict a worse outcome, but it is not the sole predicting feature. This information may be valuable during prenatal counseling.
摘要：
目的：胎儿颅内出血在产前影像学检查中很少发现。当被识别时，关于神经发育结果的稀疏数据恶化了产前困境。这项基于MRI的研究旨在评估胎儿颅内出血的产前特征和神经发育结局。
方法：一项历史队列研究，在22例胎儿MRI扫描中确定了胎儿颅内出血，作为异常产前超声检查结果评估的一部分。严重程度由新生儿常用的分级系统分级，修改。收集产前数据。神经发育结果通过Vineland-II适应性行为量表进行临床评估。
结果：8个胎儿有I-II级脑室内出血，12人患有III-IV级脑室内出血，两个人患有幕下出血。最普遍的危险因素是母亲的慢性疾病和长期使用药物。男性占主导地位。11例终止妊娠。没有参与Vineland评估的幸存儿童有IV级出血。Vineland评分在9/11儿童中正常，在2/11中中等偏低。队列的平均综合评分与年龄预期的平均评分没有差异。临床上,一个孩子有张力减退。
结论：对于未实质受累的ICH胎儿，其预后可能比从早产儿采用的脑室内出血分级量表的预期更有利。实质受累可能会预测更糟糕的结果，但这并不是唯一的预测特征。这些信息在产前咨询期间可能是有价值的。
方法：一项历史队列研究，在22例胎儿MRI扫描中确定了胎儿颅内出血，作为异常产前超声检查结果评估的一部分。严重程度由新生儿常用的分级系统分级，修改。收集产前数据。神经发育结果通过Vineland-II适应性行为量表进行临床评估。
结果：8个胎儿有I-II级脑室内出血，12人患有III-IV级脑室内出血，两个人患有幕下出血。最普遍的危险因素是母亲的慢性疾病和长期使用药物。男性占主导地位。11例终止妊娠。没有参与Vineland评估的幸存儿童有IV级出血。Vineland评分在9/11儿童中正常，在2/11中中等偏低。队列的平均综合评分与年龄预期的平均评分没有差异。临床上,一个孩子有张力减退。
结论：对于未实质受累的ICH胎儿，其预后可能比从早产儿采用的脑室内出血分级量表的预期更有利。实质受累可能会预测更糟糕的结果，但这并不是唯一的预测特征。这些信息在产前咨询期间可能是有价值的。
