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Maternal total parenteral nutrition and fetal subdural hematoma
Masatoshi Sakai1, Satoshi Yoneda, Yasushi Sasaki
1Department of Obstetrics and Gynecology, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Background:
Fetal subdural hematoma is rare, and no case resulting from vitamin K deficiency secondary to maternal total parenteral nutrition has been reported.
Case:
A 28-year-old woman was managed with total parenteral nutrition from 28 weeks' gestation because of continuous vomiting due to esophageal hiatal hernia. A sinusoidal pattern by cardiotocogram was observed at 31 weeks' gestation. Serial sonograms showed a fetal subdural hematoma, and cesarean delivery was performed. Although the maternal hepaplastin test result was normal and the maternal PIVKA-II concentration was only slightly elevated, the neonate was severely anemic and had severe vitamin K deficiency.
Conclusion:
Severe fetal vitamin K deficiency can develop even when the maternal deficiency is mild. When maternal total parenteral nutrition is necessary, supplemental vitamin K should be administered.