Beyond the bleed: Navigating fetal intraventricular hemorrhage

Background: Antenatal intraventricular hemorrhage (IVH) is intracranial hemorrhage that occurs in utero at an incidence of 1–5 per 10,000. Though there is very limited data on neurodevelopmental prognosis, antenatally diagnosed fetal intracranial hemorrhages carry a very poor prognosis with an estimated 40% mortality in utero or within the first month after birth. Less than 50% of survivors have normal neurodevelopmental outcomes during their postnatal follow-up. We present a healthy, term infant, who was prenatally diagnosed with a grade IV fetal IVH. Case: A term, male infant was delivered via elective cesarean section following a prenatal diagnosis of unilateral grade IV intraventricular hemorrhage with bilateral cerebral ventriculomegaly. Pregnancy had been unremarkable with no history of trauma, hematologic, or infectious etiology. Extensive post-natal evaluation confirmed the prenatal MRI findings and an unremarkable infectious and hematologic evaluation but revealed a genetic syndrome for 15q11.2 deletion. On day of life 18, the infant was discharged home with parents, tolerating full oral feeds and with appropriate weight gain. Continued outpatient follow-up has revealed no further progression of the bleed on serial neuroimaging with the infant meeting appropriate developmental milestones at 6 months of age. Conclusion: Despite early detection, fetal intracranial hemorrhage (ICH) has poor outcomes compared to post-natal prematurity related IVH. Parents of affected fetuses should be counseled about poor survival rates and adverse neurodevelopmental outcomes, especially following the diagnosis of grade III or IV IVH.