Our objective was to review current literature pertaining to antepartum fetal intracranial hemorrhage. To this goal we selected all manuscripts published in the English language regarding this topic obtained from a MEDLINE search for 1966 through January 1998. Additional sources were identified through cross-referencing. Antenatal fetal intracranial hemorrhage may occur spontaneously, or occur in association with various maternal or fetal conditions. Predisposing maternal conditions at risk for this occurrence include alloimmune and idiopathic thrombocytopenia, von Willebrand's disease, specific medications (warfarin) or illicit drug (cocaine) abuse, seizures, severe abdominal trauma inflicting subsequent fetal injury, amniocentesis, cholestasis of pregnancy and febrile disease. Predisposing fetal conditions include congenital factor-X and factor-V deficiencies, hemorrhage into various congenital tumors, twin-twin transfusion, demise of a co-twin, or fetomaternal hemorrhage. Currently, antepartum fetal intracranial hemorrhage may be diagnosed by imaging techniques including ultrasonography and less frequently, magnetic resonance imaging. Early real-time sonographic signs of intracranial hemorrhage consist of irregular echogenic patterns representing the associated hematoma that may clearly distort normal intracranial structures. Recent reports have suggested Doppler flow velocimetry and color Doppler imaging as additional tools in detecting fetal intracranial hemorrhage. Various types of antenatal fetal intracranial hemorrhages that have been visualized sonographically include intraventricular, periventricular, subependymal, parenchymal, subdural, and intracerebellar events. Active hemorrhages may be associated with fetal distress manifested by fetal heart rate changes. Infrequently, antenatal ultrasonographic depiction of intracranial hemorrhage may precede devastating sequelae such as hydrocephalus, hydranencephaly, porencephaly, or microcephaly. Due to the significant associated neonatal neurological impairment and potential medicolegal implications of antepartum fetal intracranial hemorrhage, it follows that obstetricians and sonographers should be familiar with predisposing factors and typical diagnostic imaging findings of these events.

Preamniocentesis counseling should emphasize the fact that, for most women, the actual pain and anxiety experienced during the procedure are significantly lower than expected. In fact, on a scale of 0-10, the mean level of pain was only 2.1, with a slightly higher mean level of anxiety.

Our objective was to review current literature pertaining to prenatal ultrasonography of various fetal intracranial neoplastic and non-neoplastic tumors. To this goal, all manuscripts published in the English language regarding this topic obtained from a MEDLINE search from 1966 through January 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Intracranial fetal tumors are extremely rare and precise diagnosis is dependent on histology examination of tissue obtained at subsequent surgery or autopsy. Currently, prenatal ultrasonographic findings associated with the following fetal intracranial tumors have been described: teratomas; neuroepithelial tumors including: glioblastoma, astrocytoma, gangliocytoma, medulloblastoma, choroid plexus, and papilloma; and mesenchymal tumors. Non-neoplastic fetal intracranial tumors are even less frequent and include: unilateral megalencephaly, heterotopia, and lipoma of the corpus callosum. Cardinal ultrasonographic findings associated with fetal intracranial tumors include: echogenic and semicystic space occupying lesions with or without distortion of normal symmetrical intracranial (usually midline) structures, calcifications, craniomegaly, polyhydramnios, obstructive hydrocephaly, high-output cardiac failure (hydrops fetalis), the presence of other associated structural anomalies, and infrequently abnormal cerebral Doppler flow velocimetry.

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US examination is performed in 15% of patients in labor and 31% of patients not in labor assessed on L+D, constituting a widely applied diagnostic tool in this environment.

Sirenomelia represents a severe developmental field defect of the posterior axis caudal blastema, resulting in partial or complete fusion of the lower limb buds. The VATER association is a combination of morphological defects including vertebral defects, anal atresia, tracheoesophageal fistula, esophageal atresia, radial and renal anomalies. The VACTERL-H association is a rare expanded form of the VATER association that includes cardiac defects, limb defects, and hydrocephalus. It has been suggested that the VATER association may represent a less severe form of sirenomelia. In this report, we document a case in which prenatal ultrasonography detected simultaneously occurring sirenomelia and hydrocephalus. Postmortem radiography and autopsy findings confirmed the prenatal diagnosis. To our knowledge, this is the first report of prenatal diagnosis of a fetus with these two abnormalities. This report supports the hypothesis that VATER association, VACTERL-H association, and sirenomelia may represent pathophysiologically related entities.

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