The distinct patterns of perinatal intracranial hemorrhage (pIH), a feared fetal and neonatal alloimmune thrombocytopenia (FNAIT) complication, were described in a recently published study in ADC Fetal and Neonatal Edition.
“The objectives of this study were to characterize neuroimaging data in correlation with perinatal and clinical risk factors of pICH and to determine whether there are differences between cases diagnosed antenatally and those diagnosed postnatally,” the authors wrote.
Learn more about FNAIT signs and symptoms
Researchers analyzed the clinical and imageneologic characteristics of 110 cases of pIH in a single center; cases associated with prematurity were excluded. In approximately 53% of cases, pIH occurred before birth.
Most hemorrhages occur in the ventricles, the cavities in the brain that produce cerebrospinal fluid. Approximately 20% of cases were subpial or subdural hemorrhages, and bleeding inside brain tissue itself represented 6% of cases.
Subpial hemorrhages were only observed postnatally, while intraventricular hemorrhages were more frequent prenatally. 20% of cases with hematological data had hematological abnormalities. Hematological abnormalities were more frequent in patients with subdural bleeding.
42% of patients underwent genetic analysis, and 31% of them had genetic abnormalities associated with bleeding. The risk factors associated with pIH were a maternal age over 31, hematological abnormalities in the mother, and placental dysfunction. The authors remarked that pIC often occurred in otherwise uneventful pregnancies.
“The interplay of maternal, perinatal and neonatal risk factors likely contributes to varying types of pICH,” the authors wrote. “ Abnormal coagulation may also contribute to postnatal pICH, while genetic factors play a more important role in prenatal ICH,”
About FNAIT and pIH
The frequency of pIH in patients with FNAIT is a disputed subject that varies across studies. Some authors suggest that pIC could affect approximately 20% of FNAIT cases, with half occurring prenatally.
pIC is associated with a poor prognosis and a significant risk of perinatal death or neurodevelopmental abnormalities in the future. Some studies suggest a mortality rate close to 50% and an incidence of neurodevelopmental abnormalities of 60%.
