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2012-07-17-13 Case of the week # 332 ©Fabrice Cuillier www.TheFetus.net  


Answer for case of the week # 332 
November 22nd,2012- December 6th, 2012

Fabrice Cuillier, MD, Mardamootoo D.*, Arcizet P.**,MD, Alessandri J.L., MD***, Balu M., MD.****
 
*            Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
**          Gynecologist, Saint-Pierre, Reunion.  
***         Department of neonatology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
****        Department of Radiology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
 
 
 
Case report :

This is a case of cerebral hemorrhage due to  fetal allo-immune thrombocytopenia. 

Fetal allo-immune thrombocytopenia (FAIT) is caused by maternal immunization against fetal platelet antigen. Intracerebral hemorrhage is the most deleterious consequence. We present a case of fetal allo-immune thrombocytopenia diagnosed by ultrasound examination, at 32 weeks. 

The patient was referred at 33 weeks for intra-cerebral anomaly. The first and the second fetal sonography showed a normal fetus. The nuchal translucency was 1 mm (LCR = 65 mm). The triple test was 1/1700.

In our antenatal unit, the admission scan immediately revealed an intra-cerebral heteroechogenic structure, without peripherical vascularisation. The homolateral ventricule seemed compressed. A left ventriculomegaly was observed (14 mm). Coronal section showed the right cerebral lesion, probably hemorragic, with different hematomas inside. The size was 54 mm x 46 mm. Parasagital view confirmed our analysis. The corpus callosus and the pericallosus artery were present.  

At 34 weeks, the size of the hematoma had increased (> 6 cm). The posterior gap was normal.

A cerebral MRI confirmed the right hemispheric hematoma and the left ventriculomegaly. The cerebral gyration was normal without anomaly of the white substance.
The parents were informed about the bad fetal and post-natal prognosis. They met a neuro-pediatric specialist.
At 35 weeks, the hematoma had increased (Figure 11,12 and Video clip). 

The parents decided to end the pregnancy. An umbilical cord blood sampling was done. The mother had a normal platelet count. The diagnosis of fetal allo-immune thrombocytopenia was confirmed by the presence of HPA-1a antibodies in maternal serum. The fetal karyotype was 46X. The fetal platelet level was 5000/ml.

Here are the images:

Figure 1-4:  At 32 weeks,  intra-cerebral hyperechogenic structure.  The homolateral ventricule seemed compressed.



Figure 5-8: 
Sagital view of the heterogenic mass at 32 weeks.  The posterior gap was normal. 


  

Figure 9, 10: The corpus callosus and the pericallosus artery were present.  




Figure 11, 12: One weeks later, the hematoma had increased in size.



Video:



Figure 13-18:  A cerebral MRI confirmed the right hemispheric hematoma and the left ventriculomegaly 

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