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Fetal stroke is a rare disease that occurs between 14 weeks of gestation and the onset of labor and can be caused by ischemic, thrombotic or hemorrhagic injury produced during pregnancy. One of the maternal conditions associated with fetal stroke is alloimmune thrombocytopenia. This needs to be differentiated from autoimmune thrombocytopenia, a condition in which mothers are previously affected. The neurological consequences of the fetal brain injury may be delayed neurological milestones, cognitive impairment, epilepsy and cortical blindness. Magnetic resonance represents the best diagnostic method to reveal prenatal brain injury.

Objective: Neonatal intracranial hemorrhage (ICH) has been estimated to be high in premature infants, occurring in approximately 40% of infants of less than 32 weeks' gestation. However, the true incidence of ICH in utero has not been determined. We present our experience with four cases of fetal ICH (fetal stroke), which was detected prenatally by ultrasonography (US). Materials and Methods: Four cases of fetal ICH were identified over a 2-year period at the prenatal unit of Taichung Veterans General Hospital, Taiwan. Prenatal and neonatal sonograms, computed tomography (CT) scan or magnetic resonance imaging (MRI), medical records, and the clinical course were assessed retrospectively. In each case, a series of initial and follow-up obstetric sonograms were available. Fetal stroke was recognized by several sonographic features: irregular echogenic brain mass, intraventricular echogenic foci or periventricular echodensities; ventriculomegaly; and posthemorrhagic hydrocephalus (PHH). A detailed investigation for possible etiology of fetal ICH was performed in all cases. Results: Transabdominal US showed hyperechoic lesions in the lateral ventricle and ventriculomegaly in three of the four fetuses, and a massive intraparenchymal hemorrhage in the remaining one. Three fetuses were born vaginally and one by cesarean section due to an enlarged head circumference. Abnormal nonstress tests and abnormal flow velocity waveforms in the umbilical and middle cerebral arteries were present in two cases. Intrapartum fetal death and neonatal death occurred in the first two cases associated with maternal preeclampsia at 31 and 27 weeks, respectively. In the remaining two infants, the one in case 3 underwent ventriculoperitoneal shunting, which developed normally at the age of 18 months. The other infant in case 4 had PHH after suspicious choroids plexus hemorrhage, and the detailed information regarding the cause of neonatal death was not available. Conclusion: This small series demonstrate that an antenatal diagnosis of fetal stroke with intraventricular hemorrhage Grades III and IV or with brain parenchymal involvement appears to be associated with poor neurologic outcome. Due to the significant neonatal neurologic impairment and potential medicolegal implications of antepartum fetal ICH, it follows that obstetricians and sonographers should be familiar with predisposing factors and typical diagnostic imaging findings of rare in utero ICH events.

Objective: Fetal intracranial hemorrhage (ICH) in utero is a rare complication of pregnancy associated with subsequent neurological sequelae or fetal death. Case report: A 34-year-old woman with Crohn's disease presented at 36 weeks' gestation due to decreased fetal movement. Fetal heart-rate tracing indicated poor beat-to-beat variability. In addition, a Doppler ultrasonography suggested a prenatal stroke with evidences of ICH, reverse-end diastolic velocity of the middle cerebral artery, and a persistent distended bladder. A nonaggressive treatment option was chosen after counseling about the unfavorable prognosis. However, 22 hours after her admission, intrauterine fetal death occurred. Conclusion: Fetal ICH in utero might be a rare yet lethal complication of Crohn's disease in pregnancy.