Case Report of Fatal Intracranial Hemorrhage Secondary to Severe Fetal Growth Restriction

Abstract

Antenatal intracranial hemorrhage (ICH) is an uncommon but serious finding, particularly in the setting of fetal growth restriction (FGR). This report describes a case of severe early-onset FGR complicated by extensive fetal ICH, highlighting the sonographic findings and pathophysiological relationship between the two conditions. A 28-week growth-restricted fetus with reversed umbilical artery end-diastolic flow and reduced fetal movements underwent detailed sonographic evaluation, including Doppler studies of the umbilical artery, middle cerebral artery (MCA), and ductus venosus. Sonography of the fetal cranial structures demonstrated progressive supratentorial and infratentorial hemorrhages, later confirmed by postmortem magnetic resonance imaging and examination. FGR is a recognized risk factor for antenatal ICH, likely related to chronic hypoxia and altered cerebrovascular autoregulation. The presence of cerebral hyperechogenicity, ventriculomegaly, or elevated MCA peak systolic velocity in a growth-restricted fetus should prompt targeted sonography of the fetal cranial structures and Doppler evaluation.