Unexplained Intracranial Haemorrhage in Utero: The Battered Fetus?

Abstract

Twenty stillborn infants with unexplained intracranial haemorrhages were identified in a review of approximately 3,500 perinatal postmortems performed between 1966 and 1982. After apparently uneventful pregnancies, fetal death occurred before the onset of labour and was recognized at a mean of 10 days before delivery; 80% had subdural haemorrhages, others had intraventricular and/or intracerebral haemorrhages, and many had haemorrhages at more than one of these sites. These haemorrhages were of sufficient size to have caused death and no other causes were found at postmortem examinations. All 20 mothers were immigrants to New Zealand from the Pacific Islands and almost all were older, married, multi-gravidas with uneventful medical histories and in stable socio-economic circumstances. In the period studied the incidence of stillbirths with unexplained intracranial haemorrhages was 1.15 per 1,000 Pacific Islander births and, at one hospital, these haemorrhages were found in 14.6% of Pacific Islander stillbirths. There were no unexplained intracranial haemorrhages in other racial groups. Prenatal subdural haemorrhage without a history of maternal trauma is extremely rare. In the absence of supporting maternal histories and other fetal or maternal injuries the possibility that these are 'battered' fetuses remains circumstantial.

Fetal Subdural Hematoma: Diagnosis in utero

“…It has been suggested that the higher incidence is due to a traumatic mechanism resulting from the abdominal massages ad ministered to pregnant women by traditional healers from this area of the world [1,18], In the present case there is no data in the anamnesis suggestive of trauma as the cause of hemorrhage.…”

Idiopathic Intracranial Haemorrhage in the Fetus

“…Following education in the antenatal clinic about the potential dangers of the technique, there was a significant drop in the incidence of these bleeds. Gunn and Becroft [2], looked at the possibility of the 'battered fetus' and concluded that the evidence remained circumstantial.…”

Antepartum Fetal Intracranial Hemorrhage, Predisposing Factors and Prenatal Sonography: A Review

“…Not surprisingly, the most common current cause of maternal blunt abdominal trauma and associated fetal intracranial hemorrhage are motor vehicle accidents, which account for approximately 70% of major maternal injuries. 31~34 Gunn et al 35 suggest maternal physical abuse may underlie many cases of unexplained fetal intracranial hemorrhages. Knuppel et al 36 described a case in which obstetrical ultrasonographic assessment of a patient at 25 weeks' gestation, following a motor vehicle accident, clearly depicted fetal intracerebral abnormalities (not seen during routine sonographic testing 4 weeks previously).…”