Fetal intracerebral hemorrhage: review of the literature and practice considerations

Mary Dunbar, Department of Pediatrics, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Sonika Agarwal, Division of Neurology & Pediatrics, Children's Hospital of Philadelphia; Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Charu Venkatesan, Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Brigitte Vollmer, Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton; Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Barbara Scelsa, Department of Pediatric Neurology, Buzzi Children's Hospital, University of Milan, Milan, Italy.
Andrea C. Pardo, Department of Pediatrics, Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Tomo Tarui, Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Anthony R. Hart, Department of Paediatric Neurology, King's College Hospital NHS Foundation Trust, London, UK.
Sarah B. Mulkey, Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Monica E. Lemmon, Department of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, England.
Dawn Gano, Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA. dawn.gano@ucsf.edu.

Document Type

Journal Article

Publication Date

3-18-2025

Journal

Pediatric research

DOI

10.1038/s41390-025-04000-5

Abstract

Fetal intracerebral hemorrhage is increasingly recognized on prenatal imaging. In this review, we discuss clinically relevant aspects of fetal intracerebral hemorrhage, including germinal matrix-intraventricular hemorrhage, as well as intraparenchymal hemorrhage. We discuss current clinical practice for prenatal counseling and postnatal management of fetal intracerebral hemorrhage, and offer practical recommendations for clinicians. We propose standardized terminology for classification of fetal intracerebral hemorrhage to be used in future research. We also highlight gaps in the literature and priorities for future research, namely the need for prospective large-scale studies to better understand underlying etiologies and neurodevelopmental outcomes in fetal intracerebral hemorrhage. IMPACT STATEMENT: We discuss the diverse etiologies and outcomes of fetal intracerebral hemorrhage, and propose standardized terminology for classification. We outline current practice and offer practical recommendations for management and counseling of fetal intracerebral hemorrhage, recognizing the need for capacity-building in the newly emerging subspecialty of fetal neurology. We highlight gaps in the literature and research priorities in fetal intracerebral hemorrhage to promote collaborative research, and the development of interventions to improve pregnancy and child outcomes.

Department

Neurology

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