Authors: Rebecca Joseph, Medical College of Georgia Stephanie Stokes, Medical College of Georgia Lee Moore, Texas Tech University Health Sciences Center at the Permian Basin Natalia Schlabritz-Lutsevich, Advanced Fertility Center James Maher, Augusta University Dept of OB ,
We present a case of an in utero fetal subdural hematoma which was identified on a standard 28-week follow-up evaluation for anatomy and growth. Transabdominal scanning demonstrated a cystic fluid collection within the fetal skull which prompted a more thorough anatomic evaluation using transvaginal scanning of the fetus in a vertex presentation. By 6 insulating through the anterior and posterior fontanelle we were able to more clearly identify the cystic structure as a organized blood clot surrounding the falx cerebri and depressing the brain parenchyma away from the skull approximately 1.8 cm. There is no evidence of intraparenchymal or intraventricular hemorrhage. Diagnostic work-up for fetal torch infection and for antiplatelet antibodies was negative. The patient had no evidence of bleeding diathesis or anticoagulation. Fetal MRI demonstrated no evidence of intraparenchymal bleeding and no evidence of old blood within the ventricular system. Sequential ultrasound evaluation has demonstrated gradual resolution of the clot and no sign of AV malformation. We are cautiously optimistic that the neurologic prognosis for this child is good despite earlier case reports, which heralded a poor neurologic outcome in cases of antenatally diagnosed subdural hematoma