Warfarin‐induced fetal intracranial subdural hematoma

Abstract

Antenatal intracranial hemorrhage is a rare cause of intrauterine fetal death, with an incidence of 4.6-5.1% in autopsy studies of stillborn fetuses. Warfarin-associated fetal bleeding is also a rare problem, with an incidence of 4.3% in the literature. We present a case of warfarin-induced subdural hematoma occurring in the second trimester.

Warfarin-Associated Fetal Intracranial Hemorrhage in Woman with Mitral Valve Replacements: A Case Report

“…Previously reported cases of warfarin-associated fetal intracranial hemorrhage in pregnant women with mechanical heart valve are shown in Table 1. [9][10][11][12][13] In most cases, the INR was kept within the therapeutic range, but the fetal intracranial hemorrhage occurred between 23 and 32 weeks of gestation. Five of seven cases had subdural hemorrhage and only one baby was alive.…”

Stillbirth Classification—Developing an International Consensus for Research

“…Hypoxia-ischemic injury in the brain of a stillborn can be expressed as germinal matrix hemorrhage, white-matter injury, or neuronal injury, and the vulnerability of different brain regions is strongly related to gestational age 69. Maternal trauma or coagulopathy may lead to large subdural hemorrhages that impair survival 70,71. Fetal CNS neoplasms are rare but can be a cause of stillbirth 72…”

Fetal warfarin syndrome

“…A review of the literature published over the subsequent 10 years (4 studies being prospective), comprising 1343 pregnancies (62% of which were anticoagulated with warfarin alone throughout), chronicles a remarkably similar story 8. Fetal wastage rates with warfarin alone were 32.9%, decreasing to 19.9% with early conversion to heparin (38.8% with heparin alone).…”