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Dunbar MJ, Woodward K, Leijser LM, Kirton A. Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta-analysis. Dev Med Child Neurol 2021; 63:144-155. [PMID: 33094492 DOI: 10.1111/dmcn.14713] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 12/29/2022]
Abstract
AIM To determine how the severity of antenatally diagnosed germinal matrix-intraventricular hemorrhage (GMH-IVH) relates to morbidity and mortality, and to explore potential risk factors. METHOD We conducted a systematic review and individual patient data meta-analysis of antenatally diagnosed fetal GMH-IVH. The primary outcomes were mortality and morbidity. Potential associations with clinical factors during pregnancy were explored. Analysis employed Fisher's exact test and logistic regression. RESULTS We included 240 cases from 80 studies. Presence of venous infarction was associated with mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.4-13.25), motor impairment (OR 103.2, 95% CI 8.6-1238), epilepsy (OR 6.46, 95% CI 2.64-16.06), and developmental delay (OR 8.55, 95% CI 2.12-48.79). Shunt placement was associated with gestational age at GMH-IVH diagnosis and in utero progression. Many cases had uncomplicated pregnancies but possible co-occurring conditions included twin gestation, small for gestational age, and congenital anomalies. INTERPRETATION Severity of fetal GMH-IVH, specifically venous infarction, is associated with overall mortality and morbidity. Risk factors for fetal GMH-IVH are poorly understood and controlled studies are required. WHAT THIS PAPER ADDS Preterm germinal matrix-intraventricular hemorrhage (GMH-IVH) grading can be applied to fetuses. Many fetal germinal matrix hemorrhages occur in otherwise typical pregnancies. Half of fetuses with post-hemorrhagic ventricular dilatation receive a shunt after delivery. Fetuses with grade I or II GMH-IVH have few sequelae. Fetuses with periventricular hemorrhagic infarction have a high burden of motor impairment.
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Affiliation(s)
- Mary J Dunbar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Clinician Investigator Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristine Woodward
- Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lara M Leijser
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Pediatrics, Section of Neurology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada
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Limperopoulos C, Folkerth R, Barnewolt CE, Connolly S, Du Plessis AJ. Posthemorrhagic cerebellar disruption mimicking Dandy-Walker malformation: fetal imaging and neuropathology findings. Semin Pediatr Neurol 2010; 17:75-81. [PMID: 20434704 DOI: 10.1016/j.spen.2010.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Catherine Limperopoulos
- Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, Montreal, Quebec, Canada.
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Degani S. Evaluation of fetal cerebrovascular circulation and brain development: the role of ultrasound and Doppler. Semin Perinatol 2009; 33:259-69. [PMID: 19631086 DOI: 10.1053/j.semperi.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human fetal brain is protected from pressure changes by autoregulation of the cerebral circulation. However, antenatal intrauterine cerebrovascular events are found to play an important role in the pathogenesis of perinatal brain damage. Changes in placental vascular resistance, cardiac contractibility, vessel compliance, and blood viscosity alter the normal dynamics of fetal cerebral circulation. The introduction of various sonographic techniques and the collection of data from the arterial and venous cerebral circulation provide a powerful tool for the evaluation of physiological and pathological hemodynamic events. Anatomic and physiological considerations of cerebral vasculature in healthy and disease states are relevant in studying brain development and variations in fetal brain blood perfusion. The major role of ultrasound and Doppler modalities in the evaluation of fetal cerebrovascular circulation is enabled by implementation of these considerations. Changes in flow characteristics in fetal cerebral vasculature can be used for clinical decision making in situations of fetal compromise, such as growth restriction and anemia.
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Affiliation(s)
- Shimon Degani
- Department of Obstetrics and Gynecology, Bnei Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
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De Keersmaecker B, Vloeberghs M, Ville Y. Fetal hydrocephalus and intrauterine cerebral ventriculoscopy: an animal model. Fetal Diagn Ther 2005; 20:445-9. [PMID: 16113570 DOI: 10.1159/000086829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/28/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to create an animal model of obstructive ventriculomegaly in the fetal lamb at 78 days of gestation by injecting maternal blood into the lateral ventricles under ultrasound guidance. METHODS An endoscope of 1.2 mm housed in a 1.6-mm trocar was introduced into the dilated lateral ventricle. The lambs were sacrificed after delivery. RESULTS All fetuses diagnosed with ventriculomegaly on ultrasound showed dilatation on the anatomical sections. The ventricles had a dilated aspect when compared to the controls. In 1 fetus the septum between the two ventricles was completely ruptured. Microscopically the ependymal cells were flattened and the cellular lining was disruptured. CONCLUSION The model proved suitable for ventriculoscopic examination at 128 days of gestation. This should allow to elaborate further on therapeutic studies in this controversial area.
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Affiliation(s)
- B De Keersmaecker
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal Poissy-Saint Germain, Poissy, France
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Abstract
Prenatal ultrasound evaluation of the fetal brain requires documentation of specific structures according to guidelines set by the American College of Radiology and the American Institute of Ultrasound in Medicine. Among these required structures are: cerebellum, cisterna magna, lateral cerebral ventricles, choroid plexus, midline falx, and cavum septum pellucidum. All these structures can be visualized in three crucial planes of imaging that include cisterna magna/cerebellum, cavum septum pellucidum, and ventricular atria. A systematic approach can be achieved by instituting a protocol that includes these three basic levels of imaging of the fetal head. These anatomical levels should be incorporated in daily routine for complete obstetric ultrasound evaluation.
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Ghi T, Simonazzi G, Perolo A, Savelli L, Sandri F, Bernardi B, Santini D, Bovicelli L, Pilu G. Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:121-130. [PMID: 12905503 DOI: 10.1002/uog.191] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Prenatal diagnosis of intracranial hemorrhage (ICH) has been widely reported. Hemorrhages may occur either within the cerebral ventricles, subdural space or infratentorial fossa. The aim of this study was to determine the sonographic criteria for the diagnosis of fetal ICH, the role of in utero magnetic resonance imaging (MRI) and the outcome of this condition. METHODS The archives of our ultrasound laboratory and the literature were searched for all cases of antenatally diagnosed ICH. A grading system was used to classify the intraventricular lesions as suggested in postnatal sonographic studies. RESULTS Adding our series of 16 fetuses to the 93 cases identified in the literature, a group of 109 fetal ICHs was obtained: 89 were intracerebral (79 intraventricular and 10 infratentorial) and 20 were subdural hemorrhages. Intraventricular lesions were mostly classified as severe (32 each for Grades III and IV). In 27 cases antenatal MRI was performed additionally to ultrasound and confirmed the sonographic findings. Of the entire group, 65 infants (59%) were reported to be alive 1 month after birth (51 intraventricular hemorrhages, three infratentorial hemorrhages, 11 subdural hematomas). At 12 months, of the 48 infants whose follow-up was available, 25 or 52% were judged neurologically normal (17/36 or 47% among the intraventricular hemorrhages, 6/9 or 66% among the hematomas, and 2/3 or 66% among the infratentorial hemorrhages). CONCLUSIONS Fetal ICH may be accurately identified and categorized by antenatal sonography. The outcome is usually poor, especially for those fetuses affected by higher-grade intraventricular hemorrhages.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
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Strigini FA, Cioni G, Canapicchi R, Nardini V, Capriello P, Carmignani A. Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:335-342. [PMID: 11778992 DOI: 10.1046/j.0960-7692.2001.00486.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The occurrence of fetal intracranial hemorrhage before labor has been repeatedly observed. The aim of this study was to evaluate the sonographic appearance of fetal intracranial hemorrhage in relation to its location. Possible causative factors were also evaluated. DESIGN Five consecutive cases of fetal intracranial hemorrhage were identified at a single ultrasound unit between 1996 and 1999. In utero magnetic resonance imaging was also performed in four of these cases. Autopsy was performed after pregnancy termination or intrauterine fetal death (one case of each), and neurological follow-up was initiated in the three surviving infants. RESULTS Hydrocephaly was the predominant sonographic finding associated with intraventricular or subependymal hemorrhage; sonography provided the correct diagnosis in the former (two cases), whereas magnetic resonance imaging was necessary in the latter. Massive intraparenchymal hemorrhage was depicted as an irregular echoic mass, whereas extradural hemorrhage had a cystic appearance. History of minor maternal physical trauma without maternal or placental injury was elicited in all cases. Ultrasound examinations performed before or shortly after the trauma were available in all cases and showed normal fetal anatomy. CONCLUSIONS The sonographic appearance of fetal intracranial hemorrhage is variable, depending on its location. Even though sonography detected an intracranial anomaly in all cases, magnetic resonance imaging was necessary to establish the hemorrhagic nature of isolated subependymal and extradural hemorrhage. The similarity of histories involving minor maternal physical trauma in all cases, together with the absence of any known factor predisposing to fetal hemorrhage, may suggest that trauma is at least a contributing factor to the pathogenesis of fetal intracranial hemorrhage.
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Affiliation(s)
- F A Strigini
- Division of Obstetrics and Gynecology, University of Pisa, Italy.
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Green PM, Wilson H, Romaniuk C, May P, Welch CR. Idiopathic intracranial haemorrhage in the fetus. Fetal Diagn Ther 1999; 14:275-8. [PMID: 10529569 DOI: 10.1159/000020938] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracranial haemorrhage in the fetus has been reported with associated mortality and morbidity. This case report describes idiopathic subdural haematomas diagnosed at 32 weeks of gestation, with delivery by caesarean section of a live male infant in good condition at 34 weeks.
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Affiliation(s)
- P M Green
- Wirral Hospital Trust, Arrowe Park Hospital, Upton/Wirral, Merseyside, UK
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Hashimoto I, Tada K, Nakatsuka M, Nakata T, Inoue N, Takata M, Kudo T, Joja I. Fetal hydrocephalus secondary to intraventricular hemorrhage diagnosed by ultrasonography and in utero fast magnetic resonance imaging. A case report. Fetal Diagn Ther 1999; 14:248-53. [PMID: 10420051 DOI: 10.1159/000020931] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although fetal hydrocephalus is commonly detected by prenatal ultrasonographic examination, posthemorrhagic hydrocephalus has rarely been observed in the fetus. We report a case of hydrocephalus secondary to intraventricular hemorrhage (IVH) diagnosed by in utero magnetic resonance imaging (MRI) at 37 + 1 weeks of gestation. Ultrasonography revealed enlargement of the bilateral ventricles and an irregular mass measuring 20 x 12 x 10 mm in the right lateral ventricle. T1-weighted images with two-dimensional fast low-angle shot (2D-FLASH) and T2-weighted images with half-Fourier single-shot turbo spin echo (HASTE) demonstrated that an old hemorrhagic clot existed in the right lateral ventricle of the fetus. Hydrocephalus secondary to IVH was confirmed by postnatal MRI and ventriculoscopy. Fast MRI is especially useful for prenatal diagnosis of fetal brain abnormalities because it minimizes the artifact of fetal movement.
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Affiliation(s)
- I Hashimoto
- Department of Obstetrics and Gynecology, Okayama University Medical School, Okayama, Japan
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Abstract
Rapid progress in noninvasive ultrasound techniques has resulted in a wide variety of clinical applications for assessment of both extracranial and intracranial arterial diseases. Recent highlights in cerebrovascular ultrasound research include imaging methods for characterization of intracranial aneurysms, use of echocontrast agents for improved evaluation of acute stroke patients and transient response harmonic imaging for depiction of brain perfusion. The important role of transcranial Doppler microembolism detection in carotid endarterectomy has been defined, new approaches to noninvasive Doppler measurement of intracranial pressure are progressing, and the clinical indications for transcranial Doppler monitoring of intracranial vasospasm to prevent secondary stroke have expanded. New functional transcranial Doppler applications, which are complementary to positron emission tomography and functional magnetic resonance imaging studies, are evolving for evaluation of functional recovery after stroke; investigation of perfusion asymmetries during complex spatial tasks; assessment of hemispheric dominance in surgical candidates for epilepsy surgery; and elucidation of temporal patterns of regional neuronal activity. With increasing sophistication of cerebrovascular ultrasound methodology, it is essential that standards for data acquisition and interpretation be established. Three recent consensus meetings have provided detailed recommendations on quantification of carotid artery stenosis, on characterization of carotid artery plaques and on microembolism detection by transcranial Doppler.
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Affiliation(s)
- M G Hennerici
- Department of Neurology, Klinikum Mannheim, University of Heidelberg, Germany.
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