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Antenatal diagnosis of fetal intraventricular hemorrhage: systematic review and meta‐analysis
Author(s) -
Dunbar Mary J,
Woodward Kristine,
Leijser Lara M,
Kirton Adam
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14713
Subject(s) - medicine , intraventricular hemorrhage , germinal matrix , odds ratio , obstetrics , gestational age , fetus , confidence interval , pregnancy , pediatrics , genetics , biology
Aim To determine how the severity of antenatally diagnosed germinal matrix‐intraventricular hemorrhage (GMH‐IVH) relates to morbidity and mortality, and to explore potential risk factors. Method We conducted a systematic review and individual patient data meta‐analysis of antenatally diagnosed fetal GMH‐IVH. The primary outcomes were mortality and morbidity. Potential associations with clinical factors during pregnancy were explored. Analysis employed Fisher’s exact test and logistic regression. Results We included 240 cases from 80 studies. Presence of venous infarction was associated with mortality (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.4–13.25), motor impairment (OR 103.2, 95% CI 8.6–1238), epilepsy (OR 6.46, 95% CI 2.64–16.06), and developmental delay (OR 8.55, 95% CI 2.12–48.79). Shunt placement was associated with gestational age at GMH‐IVH diagnosis and in utero progression. Many cases had uncomplicated pregnancies but possible co‐occurring conditions included twin gestation, small for gestational age, and congenital anomalies. Interpretation Severity of fetal GMH‐IVH, specifically venous infarction, is associated with overall mortality and morbidity. Risk factors for fetal GMH‐IVH are poorly understood and controlled studies are required. What this paper adds Preterm germinal matrix‐intraventricular hemorrhage (GMH‐IVH) grading can be applied to fetuses. Many fetal germinal matrix hemorrhages occur in otherwise typical pregnancies. Half of fetuses with post‐hemorrhagic ventricular dilatation receive a shunt after delivery. Fetuses with grade I or II GMH‐IVH have few sequelae. Fetuses with periventricular hemorrhagic infarction have a high burden of motor impairment.