Maternal Thrombophilia - Risk Factor for Fetal Cerebral Hemorrhage?

The impact of maternal thrombophilia, both for the mother and the fetus, is controversial. Early during pregnancy thrombophilia may cause abortions while placental vascular abnormalities may induce problems towards the end of the pregnancy (fetal loss, preeclampsia, placental abruption, intrauterine fetal retardation). Perinatal intraventricular hemorrhages and cerebral vascular stroke were observed in the latest years in newborns delivered after pregnancies complicated by thrombophilia, and hemorrhagic and ischemic events were seen in the absence of a predisposing or causal context and without symptoms during neonatal period. Objective Given these observations, the authors wanted to evaluate the incidence of this type of perinatal pathology using ultrasonography screening of the newborns from mothers with thrombophilia. Methods Cerebral and renal ultrasonography scans were performed between January 1, 2016 and December 31, 2017 in term newborns delivered by mothers with thrombophilia admitted in the Neonatology I Dept. of the Clinical County Emergency Hospital Sibiu. Data were collected prospectively for neonates and maternal data were retrieved from the hospital charts. Results 232 newborns delivered by mothers diagnosed with thrombophilia (gestational ages 37-40 weeks, birth weight 2620-3860 g) were evaluated through cerebral and renal ultrasound scans during the study period (prevalence of 3.96% of all the 5853 deliveries during the study period; 91 cases in 2016, 3.23%, 141 cases in 2017, 4,64%). 17 of the 232 newborns had abnormalities on the sonographic screening: 16 on the head ultrasonography and 1 on the renal scan (right hypoplastic kidney - with possible vascular pathogenesis). 7 of the 16 newborns with abnormal head ultrasound had intraventricular hemorrhages, choroid plexus cysts being observed in the other 9 cases (maximum size 3 mm). Intraventricular hemorrhages were all minor - 4 grade I, limited to the germinal matrix and 3 grade I/II, extended in the lateral ventricle but without ventricular dilatation). In all the cases the sonographic aspect was typical for old hemorrhage, with antenatal onset. All neonates with abnormal cerebral scans were delivered by Cesarean section, only in 3 cases the surgical delivery being performed after labor onset. No correlation was observed between the severity of the cerebral hemorrhage and the maternal thrombophilia type (minor/major). None of the neonates with intraventricular hemorrhage identified during screening presented symptoms suggestive for cerebral hemorrhage during hospitalization, all had an uneventful adaptation to the extrauterine life. Conclusions The results of the postnatal cerebral and renal sonographic screening of the newborns delivered from pregnancies complicated with thrombophilia are raising more questions: are these abnormalities related to maternal thrombophilia?, if maternal thrombophilia is a hereditary one can this be the reason of the hemorrhages identified postnatally, is a more careful antenatal sonographic evaluation more cost-efficient than the postnatal screening?, which is the long term impact of these cerebral hemorrhages and if these neonates can be classified as at risk for developmental and neurological abnormalities?