PMC5848104_01
Fetal heart rate and evolving ultrasound findings following fetal intracranial injury. (a) Fetal heart rate showed a normal baseline with persistent minimal variability and no accelerations or decelerations (b) 34 hours after trauma: fetal intracranial anatomy largely unremarkable as demonstrated by this transverse view at the level of the lateral ventricle. (c) 62 hours after trauma: a large hyperechoic lesion in the frontal lobe is visualized (*) as well as findings consistent with a subdural hematoma (arrows).
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Fetal heart tones were noted to have a baseline of 140 beats per minute with minimal variability and no accelerations or decelerations (Figure 1(a)). An ultrasound done approximately 34 hours into admission showed unremarkable intracranial anatomy (Figure 1(b)) with an anterior placenta and no evidence of abruption. However at this time a hyperechoic lesion in the left frontal cortex was noted, extending to the left lateral ventricle with an additional fluid collection concerning for a left subdural hematoma (Figure 1(c)).
Fetal intracranial imaging and postnatal follow-up. (a) Ultrasound at 35-week gestation demonstrates unilateral ventriculomegaly. (b) MRI at day 4 of life shows cystic encephalomalacia of the bilateral frontal and left parietal lobes and artifact consistent with a previous intraventricular hemorrhage, hemorrhagic contusion, and subdural hematoma.
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Follow-up ultrasound at 35 weeks again showed mild left ventriculomegaly (Figure 2(a)) and minimal head growth (BPD 72 mm, HC 273 mm). There was also artifact suggestive of hemosiderin deposits, consistent with prior left intraventricular hemorrhage, hemorrhagic contusion, and subdural hematoma, but no indications of skull fracture (Figure 2(b)).