Prenatal sonographic diagnosis of intracranial haemorrhage: Report of a case with a sinusoidal fetal heart rate tracing, and review of the literature

The sinusoidal fetal heart rate pattern has been described in association with severe fetal anaemia, with fetal hypoxaemia, and with the administration of parenteral narcotics. Here, we report a case of decreased fetal movement in which a sinusoidal tracing was recorded. The sonographic diagnosis of a massive fetal intracranial haemorrhage was made. A non‐interventive approach was taken and the fetus died soon after in utero. We review 28 previous cases in which the prenatal sonographic diagnosis of fetal intracranial haemorrhage was made, including the underlying maternal and fetal factors and neonatal outcomes. We propose that the sinusoidal tracing in this case was due to the intracranial bleed and suggest that fetal intracranial haemorrhage be considered in the sonographic evaluation of the fetus with a sinusoidal pattern.

[1]  S. Clark,et al.  In utero ischemic injury: sonographic diagnosis and medicolegal implications. , 1988, American journal of obstetrics and gynecology.

[2]  W. Daily,et al.  Prenatal diagnosis of intracerebellar hemorrhage: case report. , 1990, American journal of obstetrics and gynecology.

[3]  T. Gunn,et al.  Congenital Hydrocephalus Secondary To Prenatal Intracranial Haemorrhage , 1988, The Australian & New Zealand journal of obstetrics & gynaecology.

[4]  P. Arger,et al.  In utero sonographic diagnosis of intracerebral hemorrhage. , 1985, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[5]  A. Whitelaw,et al.  Factor V deficiency and antenatal intraventricular haemorrhage. , 1984, Archives of disease in childhood.

[6]  H. Cohen,et al.  Sonography of fetal intracranial hemorrhage: Unusual causes and a review of the literature , 1989, Journal of clinical ultrasound : JCU.

[7]  M. M. Reid,et al.  Sinusoidal heart rate rhythms in severe neonatal hypoxia. , 1979, Archives of disease in childhood.

[8]  R. Freeman,et al.  Sinusoidal fetal heart rate pattern: its definition and clinical significance. , 1982, American journal of obstetrics and gynecology.

[9]  D. Pretorius,et al.  In utero diagnosis of intracranial hemorrhage resulting in fetal hydrocephalus. A case report. , 1986, The Journal of reproductive medicine.

[10]  J. Kelton,et al.  Neonatal alloimmune thrombocytopenia: Spontaneous in utero intracranial hemorrhage , 1988, American journal of hematology.

[11]  M. Anderson,et al.  Sonographic detection of an in utero intracranial hemorrhage in the second trimester. , 1994, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[12]  M. Kim,et al.  Sonographic diagnosis of cerebroventricular hemorrhage in utero. , 1982, Radiology.

[13]  B. Evans,et al.  Reversible Neuromuscular Syndrome in Malnourished Children , 1989, Developmental medicine and child neurology.

[14]  R. Jeffrey,et al.  Ultrasonography of the Fetal Subarachnoid Space , 1983 .

[15]  L. Papile,et al.  Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. , 1978, The Journal of pediatrics.

[16]  S. Shinnar,et al.  Intraventricular hemorrhage in the premature infant. , 1982, The New England journal of medicine.

[17]  H. Bada,et al.  Early and late intraventricular hemorrhage: The role of obstetric factors , 1992, Obstetrics and gynecology.

[18]  T. Gunn,et al.  Subdural hemorrhage in utero. , 1985, Pediatrics.

[19]  C. W. Hohler,et al.  Real-time B scanning in the diagnosis of neonatal intracranial hemorrhage. , 1982, American journal of obstetrics and gynecology.

[20]  J. Hobbins,et al.  In utero diagnosis and management of fetal subdural hematoma. , 1991, American journal of obstetrics and gynecology.

[21]  T. C. Miller,et al.  Diagnosis of subdural hemorrhage in utero. Case report. , 1985, Journal of neurosurgery.

[22]  J. Kuller,et al.  Nonimmune Hydrops and Hydrocephalus Secondary to Fetal Intracranial Hemorrhage , 1994, American journal of perinatology.

[23]  C. Sureau,et al.  [Sinusoidal fetal cardiac rhythm. An aspect evocative of fetal distress during pregnancy]. , 1972, Journal de gynecologie, obstetrique et biologie de la reproduction.

[24]  D. O'Keeffe,et al.  Significance of fetal and neonatal sinusoidal heart rate pattern: Further clinical observatons in Rh incompatibility. , 1980, American journal of obstetrics and gynecology.

[25]  G. Bydder,et al.  Recurrent intracranial haemorrhages in utero in an infant with alloimmune thrombocytopenia. Case report , 1988, British journal of obstetrics and gynaecology.

[26]  B. Young,et al.  Fetal intraventricular hemorrhage: Sonographic diagnosis and clinical implications , 1983, Journal of clinical ultrasound : JCU.

[27]  K. Leveno,et al.  Sinusoidal Fetal Heart Rate Pattern After Intrauterine Transfusion , 1984, Obstetrics and gynecology.

[28]  C. de Sousa,et al.  Antenatally diagnosed subdural haemorrhage in congenital factor X deficiency. , 1988, Archives of disease in childhood.