Case report
This was a nonconsanguineous dichorionic twin pregnancy of a woman (G1P0), who presented to our unit at 33 weeks of pregnancy. Her ultrasound examinations performed at 13 and 23 weeks were normal. Triple test was not done. The patient was referred to our unit due to intrauterine growth restriction of one of the fetuses at 33 weeks of pregnancy. Our ultrasonographic examination revealed marked intrauterine growth restriction (estimated weight 650 g) and the fetus presented with a voluminous cerebral hyperechogenic mass, which was considered to be a subdural hematoma. Lateral cerebral ventricles were normal. The fetus showed signs of cardiac insufficiency, with cardiomegaly, pericardial effusion and abnormal umbilical artery Doppler. The second twin was normal.
Serological tests (Toxoplasmosis, Rubeola, CMV, Herpes, Chikungunya) were negative. The parents were counseled and opted for the continuation of the pregnancy. The affected fetus died one day later and the pregnancy was terminated one week later due to maternal preeclampsia.
Etiology of the intracranial hemorrhage was not completely clear but we hypothesize that the fetal suffering, hypoxia and cardiac failure may have played a role in the pathophysiology of this finding. No history of maternal trauma was noted and the mother"s examinations (TORCH blood test, alloimmune antiplatelet antibodies, platelet count, prothrombin time) were normal.
No external morphological anomalies of the dead fetus were found. Postmortal findings confirmed the presence of hemosiderin within the cerebral mass.
Images 1, 2: Transverse scans of the fetal skull showing the subdural mass consistent with hematoma.