Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: A comparison with neonatal ultrasound and relation to neurologic development

This study aimed at finding whether periventricular leukomalacia (PVL) and peri- and intraventricular hemorrhage can be identified in fetuses at risk for preterm birth. Transvaginal cerebral sonography was carried out prenatally in 26 fetuses at risk because of uteroplacental insufficiency. Sonography was carried out at entry to the study and then weekly until delivery. It also was performed within 24 hours after birth and then biweekly until discharge. Criteria for inclusion in the study were severe intrauterine growth restriction (sonographic abdominal circumference less than the 5th percentile; and/or severe preeclampsia; and/or hemolysis, elevated liver enzymes, low platelet count [HELLP]) syndrome. Women with preterm membrane rupture were excluded. The mean gestational age at birth was 31 weeks, and the mean birth weight was 1089 g. Thirty cerebral ultrasound studies were done in the 21 fetuses having a cephalic presentation. Visualization in the coronal and sagittal planes was inadequate in 2 instances but was as successful overall as in a control population. No neurologic abnormalities were found in 5 fetuses exhibiting no more than minor abnormality on all their ultrasound scans. A total of 11 cerebral abnormalities were found in 9 fetuses, most commonly localized thalamic densities and periventricular echo densities. Two scans demonstrated intraventricular hemorrhage. Abnormalities persisted postnatally in 6 cases. Neurologic assessment at age 2 years showed abnormalities in 3 of these infants; 2 others were normal, and 1 was lost to follow up. All infants with normal postnatal scans did well. Five infants with normal antenatal scans exhibited sonographic abnormalities after birth; 4 had grade 1 PVL, the least severe grade, and 1 had grade 2 PVL. One of the 3 infants followed up after birth developed spastic tetraplegia. Abnormal antenatal scans in the group as a whole correlated significantly with gestational age at birth. Transvaginal ultrasound scanning is a practical measure in both low- and high-risk fetuses. When fetuses at risk of preterm birth have sonographic abnormalities suggesting imminent ischemic brain damage that persist postnatally, an adverse neurologic outcome is not unexpected.