Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Gynecology and Obstetrics Department, Maternidade Alfredo da Costa, Lisbon, Portugal
Divulgação:
-ESMNR 2015, 13-16 May 2015, Porto, Portugal
Resumo:
Introduction:
Subdural hematoma (SDH) is a frequent finding in newborns, but antenatal SDH is exceptional. Risk factors include trauma and other maternal or fetal conditions: coagulopathies, infections and iatrogenic effect of drugs, namely vitamin K antagonists; they cross placental barrier and exposure in the second or third trimesters is associated with central nervous system (CNS) malformations or hemorrhagic complications.
We present a rare case of extensive, acenocoumarol-associated SDH occurring in the third trimester, emphasizing the importance of anticoagulation as a cause of antenatal intracranial bleeding and the major role played by fetal magnetic resonance imaging (MRI) in its diagnosis.
Case Description:
A 24-year-old woman under anti-coagulation for prosthetic mitral valve became pregnant. Due to maternal high thromboembolic risk, it was decided to maintain treatment with acenocoumarol throughout the gestation, with bi-weekly ultrasound (US) evaluations. Routine US at 35 weeks of gestation was suggestive of enlarged extra-cerebral space and fetal MRI performed the following day revealed an extensive SDH involving both hemispheric convexities and the tentorium, with significant mass effect. The fetus died 2 days later and autopsy confirmed the imaging diagnosis.
Conclusion/Discussion:
Anticoagulant-associated fetal hemorrhage is a rare but severe event. There is no alternative regimen that can effectively replace vitamin K antagonists in women with mechanical heart valves. Although US studies are valuable for regular monitoring, MRI offers a more detailed assessment of fetal CNS and provides a better characterization of both hemorrhagic and malformative pathology.