Prenatal Diagnosis And Follow-up Study Of Fetal Intracranial Hemorrhage

Objective:The aim of this study is to investigate the prenatal diagnosis,pregnancy outcome,physical growth and neuropsychological development of fetal intracranial hemorrhage?FICH?.It is expected to provide evidence for clinical treatment.Methods:Collect totally 48 cases that have been actually diagnosed as fetal intracranial hemorrhage through magnetic resonance imaging?MRI?and who were suspected of fetal brain abnormalities by ultrasound initially in Fujian Provincial Maternity and Childen's Hospital during January 2013 to November 2018.To analyse the imaging of MRI and ultrasound,clinical data and pregnancy outcome of the cases with FICH,the cases were divided into four groups:FICH grade?,FICH grade?,FICH grade?and FICH grade?.Case control study was conducted on 18 cases of surviving infants with FICH as a case group,and 72 cases of infants which had a normal obstetric examination were randomly selected into control group accordance with age of mothers and infants being 1 to 4 ratio.Physical growth and neuropsychological development of infants in two groups were respectively compared by Z score and neuropsychological development examination table for children aged 0⁶ years old.Fisher's exact test and t test were conducted with SPSS 19.0 statistical software.Results:1.48 cases of FICH were detected by MRI,and 18 cases of FICH were detected by ultrasound.The detection rate of FICH in MRI was significantly higher than that in ultrasound at 24 to 27⁺⁶weeks,28 to 31⁺⁶weeks and 32 to 35⁺⁶weeks?P<0.05?,the difference was statistically significant?P<0.05?.2.The survival rate of FICH was 37.5%?18 in 48?,the rate of induced labor was 54.2%?26 in 48?,the fetal death and intrauterine death accounted for 6.25%?3 in48?,and the rate of loss of follow-up was 2.1%?1 in 48?.The FICH grade?survival rate was 76.9%?10 in 13?,the rate of induced labor was 23.1%?3 in 13?,two of them were complicated with extra-nervous system abnormality,and another one was merged with neurologic abnormality.The rate of FICH grade?induction was 80%?4 in 5?,75%?3 in 4?were merged with neurologic abnormality.The rate of FICH grade?induction was 100%?1 in 1?.The survival rate of FICH grade?was 27.6%?8 in 29?and the induced rate was 62.1%?18 in 29?.The fetal death and intrauterine death accounted for 10.3%?3 in 29?.3.There was no significant difference in the gestational age and birth weight between the case group and the control group,and the Apgar score was 10 points.There was no significant difference in physical growth development between the two groups.The score of fine motor and social behavior in the case group were lower than those in the control group?P<0.05?.The large exercise,adaptability,language,and developmental quotient?DQ?in the case group and the control group have no significant difference.One case of FICH grade?had low developmental quotient?DQ=63.9?at 6 months after birth,which was characterized by poor fine motor,adaptability and social behavior,received regular rehabilitation training and developed moderately?DQ=90.0?after 16 months of life.One case of FICH grade?with intracranial softening lesion,who developed a right limb dyskinesia after birth,received regular rehabilitation treatment.No progress lesions was found in MRI,muscle strength of right limb was improved,muscle tension was decreased and DQ was 82.7 at 33 months after birth.One child of FICH grade?with intracranial softening lesion and hydrocephalus was diagnosed as right limb dyskinesia after birth.MRI showed that hydrocephalus was aggravated and no rehabilitation treatment was performed.DQ was 73.2 at 17 months after birth.The poor prognosis of FICH accounted for 5.6%?1 in 18?.Conclusions:1.MRI can clearly show the location,extent and combined abnormalities of FICH compared with ultrasound.MRI should be performed in fetuses with suspected intracranial hemorrhage by ultrasound.2.FICH grade?fetuses without merged abnormality,isolated cerebellar hemorrhage and intracranial lesions with no progression of FICH grade?fetus had a good prognosis.It was not recommended to terminate the pregnancy blindly.Close follow-up and reexamination of brain ultrasound or MRI after birth should be performed.3.Attention should be paid to the assessment of the neuropsychological development of the infants with FICH,especially in fine motor and social behavior.If abnormalities are found,early intervention should be made to enable the brain potential to be excavated as far as possible in order to prevent or reduce the occurrence of disability,to improve prognosis.