Fetal Encephalomalacia Secondary to Acute Maternal Blood Loss: A Case Study

Shabih      Manzar

doi:10.2174/03666220921085212

Abstract

Background: Fetal neurons are sensitive to ischemia which could happen secondary to acute maternal blood loss. The damage to the fetal brain with loss of brain neurons in early gestation leads to encephalomalacia. We describe here a case report of fetal encephalomalacia secondary to acute maternal blood loss.

Case Presentation: A 23-year-old gravida 3, para 2 woman sustained a forearm laceration at 18 weeks of gestation. Her hemoglobin dropped to 7.9 mg/dL. A surgical laceration repair was completed, and she was transfused with blood. At the OB visit the following week, her fetal US showed abnormal brain, evident by the increased size of the lateral ventricles. A follow-up MRI at 30 weeks of gestation confirmed fetal encephalomalacia. A complete investigation, including free cell maternal DNA for chromosomal anomalies, TORCH infection, and Covid PCR, all were negative. Conclusion:

We concluded from the case that any history of significant acute maternal blood loss that required blood transfusion should necessitate a fetal ultrasound to look for fetal well-being, especially for any brain structural changes in the developing brain.

Keywords: Maternal, Blood loss, Fetal, Encephalomalacia, Transfusion, Ultrasound, Case report

[1]
Inder TE, Volpe JJ. Mechanisms of perinatal brain injury. Semin Neonatol  2000; 5(1): 3-16.
 [http://dx.doi.org/10.1053/siny.1999.0112] [PMID: 10802746]

[2]
Volpe JJ. Neurobiology of periventricular leukomalacia in the premature infant. Pediatr Res  2001; 50(5): 553-62.
 [http://dx.doi.org/10.1203/00006450-200111000-00003] [PMID: 11641446]

[3]
Love R, Matiasek A, Carter W, Ylagan M, Lee A. Prenatal diagnosis of fetal encephalomalacia after maternal diabetic ketoacidosis. AJP Rep  2014; 4(2): e97-e100.
 [http://dx.doi.org/10.1055/s-0034-1395990] [PMID: 25452892]

[4]
Verma PK, Panerai RB, Rennie JM, Evans DH. Grading of cerebral autoregulation in preterm and term neonates. Pediatr Neurol  2000; 23(3): 236-42.
 [http://dx.doi.org/10.1016/S0887-8994(00)00184-3] [PMID: 11033287]

[5]
Gilles FH, Leviton A. Neonatal white matter damage and the fetal inflammatory response. Semin Fetal Neonatal Med  2020; 25(4)101111
 [http://dx.doi.org/10.1016/j.siny.2020.101111] [PMID: 32299712]

[6]
So PL, Li KW, Yeung TW, Sin WK. Multicystic encephalomalacia and gastrointestinal injury following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy: A case report. BMC Pregnancy Childbirth  2019; 19(1): 311.
 [http://dx.doi.org/10.1186/s12884-019-2459-4]

[7]
Novak CM, Ozen M, Burd I. Perinatal Brain Injury. Clin Perinatol  2018; 45(2): 357-75.
 [http://dx.doi.org/10.1016/j.clp.2018.01.015] [PMID: 29747893]

[8]
Chu CH, Sung CC, Hu CF, Chen SJ. Neonatal seizure caused by periventricular leukomalacia resulting from maternal protein S deficiency and treated with aspirin. Pediatr Neonatol  2022; 63(1): 86-8.
 [http://dx.doi.org/10.1016/j.pedneo.2021.08.017] [PMID: 34836816]

[9]
Bharti D. Intrauterine cerebral infarcts and bilateral frontal cortical leukomalacia following chronic maternal inhalation of carburetor cleaning fluid during pregnancy. J Perinatol  2003; 23(8): 693-6.
 [http://dx.doi.org/10.1038/sj.jp.7211005] [PMID: 14647172]