title: Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?
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.
  
  
  METHODS
  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.
authors.affiliation: Division of Obstetrics and Gynecology, University of Pisa, Italy. f.strigini@obgyn.med.unipi.it
authors.forename: F A
authors.initials: FA
authors.lastname: Strigini
authors.forename: G
authors.initials: G
authors.lastname: Cioni
authors.forename: R
authors.initials: R
authors.lastname: Canapicchi
authors.forename: V
authors.initials: V
authors.lastname: Nardini
authors.forename: P
authors.initials: P
authors.lastname: Capriello
authors.forename: A
authors.initials: A
authors.lastname: Carmignani
mesh_terms: D015984:Causality; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D016216:Ultrasonography, Prenatal; D014947:Wounds and Injuries / Q000150:complications*