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.