Antenatally Diagnosed Fetal Subdural Hematoma: A Case Report
,
Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease that affects babies in which the platelet count is decreased because the mother's immune system attacks her fetus platelets. A low platelet count increases the risk of bleeding in the fetus and newborn. FNAIT is the leading cause of severe thrombocytopenia in the fetus and neonate. The most serious complication of FNAIT is intracranial hemorrhage, which occurs in 10-20% of symptomatic infants. If the bleeding occurs in the brain, there may be long-term effects. The Pathophysiology of atraumatic fetal subdural hematoma (SDH) remains unknown and is extrapolated from SDH of shaken baby syndrome in infants (1, 2). Detailed prenatal investigation is crucial to elucidate the underlying etiology, which may be associated with a better prognosis. We present a case of antenatally diagnosed SDH secondary to FNAIT that was normal up to one month after follow-up.
[1] Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. Journal of Neurosurgery. 1987; 66(3):409-15. [DOI:10.3171/jns.1987.66.3.0409] [PMID]
[2] Brown JK, Minns RA. Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects. Developmental Medicine & Child Neurology. 1993; 35(10):849-69. [DOI:10.1111/j.1469-8749.1993.tb11563.x] [PMID]
[3] Vergani P, Strobelt N, Locatelli A, Paterlini G, Tagliabue P, Parravicini E, et al. Clinical significance of fetal intracranial hemorrhage. Ameri- can Journal of Obstetrics and Gynecology. 1996; 175(3):536-43. [DOI:10.1053/ob.1996.v175.a73598] [PMID]
[4] Kutuk MS, Yikilmaz A, Ozgun MT, Dolanbay M, Canpolat M, Uludag S, et al. Prenatal diagnosis and postnatal outcome of fetal intrac- ranial hemorrhage. Child’s Nervous System. 2014; 30(3):411-18. [DOI:10.1007/s00381-013-2243-0] [PMID]
[5] Abdelkader MA, Ramadan W, Gabr AA, Kamel A, Abdelrahman RW. Fetal intracranial hemorrhage: sonographic criteria and mer- its of prenatal diagnosis. The Journal of Maternal-Fetal & Neonatal Medicine. 2017; 30(18):2250-6. [DOI:10.1080/14767058.2016.124 5283] [PMID]
[6] Putbrese B, Kennedy A. Findings and differential diagnosis of fe- tal intracranial hemorrhage and fetal ischemic brain injury: What is the role of fetal MRI? The British Journal of Radiology. 2017; 90(1070):20160253. [DOI:10.1259/bjr.20160253] [PMID] [PMCID]
[7] Cheung KW, Tan LN, Seto MTY, Moholkar S, Masson G, Kilby MD. Prenatal diagnosis, management, and outcome of fetal subdural he- matoma: A case report and systematic review. Fetal Diagnosis and Therapy. 2019; 46(5):285-95. [DOI:10.1159/000496202] [PMID]
[8] Larroche JC. Fetal cerebral pathology of circulatory origin. In: Lev- ene MI, Lilford LJ, editors. Fetal and Neonatal Neurology and Neu- rosurgery. Edinburg: Churchill Livingstone; 1994. 321-324.Fetal and neonatal neurology and neurosurgery (1994 edition) | Open Library
[9] Regan F, Lees CC, Jones B, Nicolaides KH, Wimalasundera RC, Mi- hovic A. Royal college of obstetricians and gynaecologists. Prenatal management of pregnancies at risk of fetal neonatal alloimmune thrombocytopenia (FNAIT). An International Journal of Obstet- rics and Gynecology. 2019; 126(10):173-85. [DOI:10.1111/1471- 0528.15642] [PMID]
[10] Akman CI, Cracco J. Intrauterine subdural hemorrhage. Devel- opmental Medicine and Child Neurology. 2000; 42(12):843-6. [DOI:10.1111/j.1469-8749.2000.tb00699.x][PMID]
[11] Chi T, Simonnazi G, Perolo A, Savelli L, Sandri F, Bernardi B, et al. Outcome of antenatally diagnosed intracranial hemorrhage: Case series and review of the literature. Ultrasound in Obstetrics and Gy- necology. 2003; 22(2):121-30. [DOI:10.1002/uog.191] [PMID]
[12] Birchall JE, Murphy MF, Kaplan C, Kroll H. European feto-maternal alloimmune thrombocytopenia study group. European collabora- tive studyof the antenatal management of feto-maternal alloim- mune thrombocytopenia. British Journal of Haematology. 2003; 122(2):275-88. [DOI:10.1046/j.1365-2141.2003.04408.x] [PMID]
[13] Kahai HH, van den Akker ES, Walther FJ, Brand A. Intravenous immunoglobulins without initial and follow-up cordocentesis in alloimmune fetal and neonatal thrombocytopenia at high risk for intracranial hemorrhage. Fetal Diagnosis and Therapy. 2006; 21(1):55-60. [DOI:10.1159/000089048] [PMID]
[14] Sringini FAL, Cioni G, Canapicchi R, Nardini V, Carpiello P, Carmi- gnani A. Fetal intracranial hemorrhage: Is minor maternal trauma a possible pathogenic factor? Ultrasound Obstet Gynecol. 2001; 18(4):335-42. [DOI:10.1046/j.0960-7692.2001.00486.x] [PMID]
[15] Belfer HL, Kuller JA, Hill LM, Kislak S. Evolving fetal hydranenceph- aly mimicking intracranial neoplasm. Journal of Ultrasound in Medi- cine. 1991; 10(4):231-33. [DOI:10.7863/jum.1991.10.4.231] [PMID]
[16] Bondurant S, Boehm FH, Fleischer AC, Machin JE. Antepartum di- agnosis of fetal intracranial hemorrhage by ultrasound. Obstetrics and Gynecology. 1984; 63(3 Suppl):25S-7S. [PMID]
[17] Leidig E, Dannecker G, Pfeiffer KH, Salinas R, Peiffer J. Intrauterine development of posthemorrhagic hydrocephalous. European Journal of Pediatrics. 1998; 147(1):26-9. [DOI:10.1007/BF00442606] [PMID]
[18] De Vries LS, Connell J, Bydder GM, Dubowitz LMS, Rodeck CH, Mibashan RS, et al. Recurrent intracranial hemorrhage in utero in an infant with alloimmune thrombocytopenia. Case Report. BJOG: An International Journal of Obstetrics & Gynaecology. 1998; 95(3):299-302. [DOI:10.1111/j.1471-0528.1988.tb06873.x] [PMID]
[19] Gunn TR, Mok PM, Becroft DM. Subdural hemorrhage in utero. Pediatrics. 1985; 76(4):605-10. [DOI:10.1542/peds.76.4.605] [PMID]
[20] Gunn TR, Mora JD, Becroft DMO. Congenital hydrocephalous sec- ondary to prenatal intracranial hemorrhage. Australian and New Zealand Journal of Obstetrics and Gynaecology. 1988; 28(3):197-200. [DOI:10.1111/j.1479-828X.1988.tb01663.x] [PMID]
[21] Farmer DL, Adzick NS, Crombleholme WR, Crombleholme TM, Longaker MT, Harrison MR. Fetal trauma: Relation to maternal inju- ry. Journal of Pediatric Surgery. 1990; 25(7):711-14. [DOI:10.1016/ S0022-3468(05)80002-8][PMID]
[22] Chames MC, Pearlman MD. Trauma during pregnancy: Outcomes and clinical management. Clinical Obstetrics and Gynecology. 2008; 51(2):398-408. [DOI:10.1097/GRF.0b013e31816f2aa7] [PMID] [23] Mastushita H, Harada A, Sato T, Kurabayashi T. Fetal intracranial injuries following motor vehicle accidents with airbag deployment. Journal of Obstetrics and Gynaecology Research. 2014; 40(2):599-602. [DOI:10.1111/jog.12188] [PMID]
[24] American College of Obstetricians and Gynecologists Women s Health Care Physicians. ACOG Practice Bulletin No. 138: Inher- ited thrombophilias in pregnancy. Obstetrics Gynecology. 2013; 122(3):706-16. [DOI:10.1097/01.AOG.0000433981.36184.4e] [PMID]
[25] Katz D, Beilin Y. Disorders of coagulation in pregnancy. British Journal of Anaesthesia. 2015; 115(Suppl 2):ii75-ii88. [DOI:10.1093/ bja/aev374] [PMID]
[26] Bussel JB, Zacharoulis S, Kramer K, McFarland JG, Pauliny J, Ka- plan C. Clinical and diagnostic comparison of neonatal alloim- mune thrombocytopenia to non-immune cases of thrombocyto- penia. Pediatr Blood Cancer. 2005; 45(2):176-83. [DOI:10.1002/ pbc.20282] [PMID]
[27] Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. New England Journal of Medicine.1993; 329(20):14636. [DOI:10.1056/NEJM199311113292005] [PMID]
[28] Dreyfus M, Kaplan C, Verdy E, Schlegel N, Durand-Zaleski I, Tcher- nia G. Frequency of immune thrombocytopenia in newborns: A pro- spective study. Immune thrombocytopenia working group. Blood. 1997; 89(12):4402-6. [DOI:10.1182/blood.V89.12.4402] [PMID]
[29] Pearson HA, Shulman NR, Marder VJ, Cone TJR. Isoimmune neonatal thrombocytopenic purpura. Clinical and therapeutic considerations. Blood; 1964; 23(2):154-77. [DOI:10.1182/blood. V23.2.154.154] [PMID]
[30] Knight M, Pierce M, Allen D, Kurinczuk JJ, Spark P, Roberts DJ et al. The incidence and outcomes of feto-maternal alloimmune throm- bocytopenia: A UK national study using three data sources. British Journal of Haematology. 2011; 152(2):460-8. [DOI:10.1111/j.1365- 2141.2010.08540.x] [PMID]
[31] Mueller-Eckhardt C, Kiefel V, Grubert A, Kroll H, Weisheit M, Schmidt S, et al. 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet. 1989; 333(8634):363-6. [DOI:10.1016/ S0140-6736(89)91733-9][PMID]
[32] Bussel JB, Zabusky MR, Berkowitz RL, McFarland JG. Fetal alloim- mune thrombocytopenia. New England Journal of Medicine. 1997; 337(1):22-6. [DOI:10.1056/NEJM199707033370104] [PMID]
[33] Spencer JA, Burrows RF. Feto-maternal alloimmune thrombo- cytopenia: A literature review and statistical analysis. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2001; 41(1):45-55. [DOI:10.1111/j.1479-828X.2001.tb01293.x] [PMID]
[34] Tiller H, Kamphuis MM, Flodmark O, Papadogiannakis N, David AL, Sainio S, et al. Fetal intracranial hemorrhage caused by fetal and neonatal alloimmune thrombocytopenia: An observational cohort sudy of 43 cases from an international multicenter registry. BMJ Open. 2013; 3(3):e0024490. [DOI:10.1136/bmjopen-2012-002490] [PMID] [PMCID]
[35] van den Akker ESA, Oepkes D, Lopriore E, Brand A, Kanhai HHH. Non-invasive antenatal management of fetal and neonatal alloim- mune thrombocytopenia: Safe and effective. BJOG: An Interna- tional Journal of Obstetrics & Gynaecology. 2007; 114(4):469-73. [DOI:10.1111/j.1471-0528.2007.01244.x] [PMID]
[36] Berkowitz RL, Kolb EA, McFarland JG, Wissert M, Primani A, Lesser M, et al. Parallel randomixzed trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstetrics & Gynecology. 2006; 107(1):91-6. [DOI:10.1097/01.AOG.0000192404.25780.68] [PMID]
[37] Rayment R, Brunskill SJ, Sothilll PW, Roberts DJ, Bussel JB, Murphy MF. Antenatal interventions for feto-maternal alloimmune thrombocyto- penia. Cochrane Database of Systematic Reviews. 2011;(5):CD004226. [DOI:10.1002/14651858.CD004226.pub3] [PMID]
[38] van der Lugt NM, Kamphius MM, Paridaans NPM, Figee A, Oepkes D, Walther FJ, et al. Neonatal outcome in alloimmune thrombocyto- penia after maternal treatment with intravenous immunoglobulin. Blood Transfusion. 2015; 13(1):66-71. [DOI:10.2450/2014.0309-13] [PMID][PMCID]
[2] Brown JK, Minns RA. Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects. Developmental Medicine & Child Neurology. 1993; 35(10):849-69. [DOI:10.1111/j.1469-8749.1993.tb11563.x] [PMID]
[3] Vergani P, Strobelt N, Locatelli A, Paterlini G, Tagliabue P, Parravicini E, et al. Clinical significance of fetal intracranial hemorrhage. Ameri- can Journal of Obstetrics and Gynecology. 1996; 175(3):536-43. [DOI:10.1053/ob.1996.v175.a73598] [PMID]
[4] Kutuk MS, Yikilmaz A, Ozgun MT, Dolanbay M, Canpolat M, Uludag S, et al. Prenatal diagnosis and postnatal outcome of fetal intrac- ranial hemorrhage. Child’s Nervous System. 2014; 30(3):411-18. [DOI:10.1007/s00381-013-2243-0] [PMID]
[5] Abdelkader MA, Ramadan W, Gabr AA, Kamel A, Abdelrahman RW. Fetal intracranial hemorrhage: sonographic criteria and mer- its of prenatal diagnosis. The Journal of Maternal-Fetal & Neonatal Medicine. 2017; 30(18):2250-6. [DOI:10.1080/14767058.2016.124 5283] [PMID]
[6] Putbrese B, Kennedy A. Findings and differential diagnosis of fe- tal intracranial hemorrhage and fetal ischemic brain injury: What is the role of fetal MRI? The British Journal of Radiology. 2017; 90(1070):20160253. [DOI:10.1259/bjr.20160253] [PMID] [PMCID]
[7] Cheung KW, Tan LN, Seto MTY, Moholkar S, Masson G, Kilby MD. Prenatal diagnosis, management, and outcome of fetal subdural he- matoma: A case report and systematic review. Fetal Diagnosis and Therapy. 2019; 46(5):285-95. [DOI:10.1159/000496202] [PMID]
[8] Larroche JC. Fetal cerebral pathology of circulatory origin. In: Lev- ene MI, Lilford LJ, editors. Fetal and Neonatal Neurology and Neu- rosurgery. Edinburg: Churchill Livingstone; 1994. 321-324.Fetal and neonatal neurology and neurosurgery (1994 edition) | Open Library
[9] Regan F, Lees CC, Jones B, Nicolaides KH, Wimalasundera RC, Mi- hovic A. Royal college of obstetricians and gynaecologists. Prenatal management of pregnancies at risk of fetal neonatal alloimmune thrombocytopenia (FNAIT). An International Journal of Obstet- rics and Gynecology. 2019; 126(10):173-85. [DOI:10.1111/1471- 0528.15642] [PMID]
[10] Akman CI, Cracco J. Intrauterine subdural hemorrhage. Devel- opmental Medicine and Child Neurology. 2000; 42(12):843-6. [DOI:10.1111/j.1469-8749.2000.tb00699.x][PMID]
[11] Chi T, Simonnazi G, Perolo A, Savelli L, Sandri F, Bernardi B, et al. Outcome of antenatally diagnosed intracranial hemorrhage: Case series and review of the literature. Ultrasound in Obstetrics and Gy- necology. 2003; 22(2):121-30. [DOI:10.1002/uog.191] [PMID]
[12] Birchall JE, Murphy MF, Kaplan C, Kroll H. European feto-maternal alloimmune thrombocytopenia study group. European collabora- tive studyof the antenatal management of feto-maternal alloim- mune thrombocytopenia. British Journal of Haematology. 2003; 122(2):275-88. [DOI:10.1046/j.1365-2141.2003.04408.x] [PMID]
[13] Kahai HH, van den Akker ES, Walther FJ, Brand A. Intravenous immunoglobulins without initial and follow-up cordocentesis in alloimmune fetal and neonatal thrombocytopenia at high risk for intracranial hemorrhage. Fetal Diagnosis and Therapy. 2006; 21(1):55-60. [DOI:10.1159/000089048] [PMID]
[14] Sringini FAL, Cioni G, Canapicchi R, Nardini V, Carpiello P, Carmi- gnani A. Fetal intracranial hemorrhage: Is minor maternal trauma a possible pathogenic factor? Ultrasound Obstet Gynecol. 2001; 18(4):335-42. [DOI:10.1046/j.0960-7692.2001.00486.x] [PMID]
[15] Belfer HL, Kuller JA, Hill LM, Kislak S. Evolving fetal hydranenceph- aly mimicking intracranial neoplasm. Journal of Ultrasound in Medi- cine. 1991; 10(4):231-33. [DOI:10.7863/jum.1991.10.4.231] [PMID]
[16] Bondurant S, Boehm FH, Fleischer AC, Machin JE. Antepartum di- agnosis of fetal intracranial hemorrhage by ultrasound. Obstetrics and Gynecology. 1984; 63(3 Suppl):25S-7S. [PMID]
[17] Leidig E, Dannecker G, Pfeiffer KH, Salinas R, Peiffer J. Intrauterine development of posthemorrhagic hydrocephalous. European Journal of Pediatrics. 1998; 147(1):26-9. [DOI:10.1007/BF00442606] [PMID]
[18] De Vries LS, Connell J, Bydder GM, Dubowitz LMS, Rodeck CH, Mibashan RS, et al. Recurrent intracranial hemorrhage in utero in an infant with alloimmune thrombocytopenia. Case Report. BJOG: An International Journal of Obstetrics & Gynaecology. 1998; 95(3):299-302. [DOI:10.1111/j.1471-0528.1988.tb06873.x] [PMID]
[19] Gunn TR, Mok PM, Becroft DM. Subdural hemorrhage in utero. Pediatrics. 1985; 76(4):605-10. [DOI:10.1542/peds.76.4.605] [PMID]
[20] Gunn TR, Mora JD, Becroft DMO. Congenital hydrocephalous sec- ondary to prenatal intracranial hemorrhage. Australian and New Zealand Journal of Obstetrics and Gynaecology. 1988; 28(3):197-200. [DOI:10.1111/j.1479-828X.1988.tb01663.x] [PMID]
[21] Farmer DL, Adzick NS, Crombleholme WR, Crombleholme TM, Longaker MT, Harrison MR. Fetal trauma: Relation to maternal inju- ry. Journal of Pediatric Surgery. 1990; 25(7):711-14. [DOI:10.1016/ S0022-3468(05)80002-8][PMID]
[22] Chames MC, Pearlman MD. Trauma during pregnancy: Outcomes and clinical management. Clinical Obstetrics and Gynecology. 2008; 51(2):398-408. [DOI:10.1097/GRF.0b013e31816f2aa7] [PMID] [23] Mastushita H, Harada A, Sato T, Kurabayashi T. Fetal intracranial injuries following motor vehicle accidents with airbag deployment. Journal of Obstetrics and Gynaecology Research. 2014; 40(2):599-602. [DOI:10.1111/jog.12188] [PMID]
[24] American College of Obstetricians and Gynecologists Women s Health Care Physicians. ACOG Practice Bulletin No. 138: Inher- ited thrombophilias in pregnancy. Obstetrics Gynecology. 2013; 122(3):706-16. [DOI:10.1097/01.AOG.0000433981.36184.4e] [PMID]
[25] Katz D, Beilin Y. Disorders of coagulation in pregnancy. British Journal of Anaesthesia. 2015; 115(Suppl 2):ii75-ii88. [DOI:10.1093/ bja/aev374] [PMID]
[26] Bussel JB, Zacharoulis S, Kramer K, McFarland JG, Pauliny J, Ka- plan C. Clinical and diagnostic comparison of neonatal alloim- mune thrombocytopenia to non-immune cases of thrombocyto- penia. Pediatr Blood Cancer. 2005; 45(2):176-83. [DOI:10.1002/ pbc.20282] [PMID]
[27] Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. New England Journal of Medicine.1993; 329(20):14636. [DOI:10.1056/NEJM199311113292005] [PMID]
[28] Dreyfus M, Kaplan C, Verdy E, Schlegel N, Durand-Zaleski I, Tcher- nia G. Frequency of immune thrombocytopenia in newborns: A pro- spective study. Immune thrombocytopenia working group. Blood. 1997; 89(12):4402-6. [DOI:10.1182/blood.V89.12.4402] [PMID]
[29] Pearson HA, Shulman NR, Marder VJ, Cone TJR. Isoimmune neonatal thrombocytopenic purpura. Clinical and therapeutic considerations. Blood; 1964; 23(2):154-77. [DOI:10.1182/blood. V23.2.154.154] [PMID]
[30] Knight M, Pierce M, Allen D, Kurinczuk JJ, Spark P, Roberts DJ et al. The incidence and outcomes of feto-maternal alloimmune throm- bocytopenia: A UK national study using three data sources. British Journal of Haematology. 2011; 152(2):460-8. [DOI:10.1111/j.1365- 2141.2010.08540.x] [PMID]
[31] Mueller-Eckhardt C, Kiefel V, Grubert A, Kroll H, Weisheit M, Schmidt S, et al. 348 cases of suspected neonatal alloimmune thrombocytopenia. Lancet. 1989; 333(8634):363-6. [DOI:10.1016/ S0140-6736(89)91733-9][PMID]
[32] Bussel JB, Zabusky MR, Berkowitz RL, McFarland JG. Fetal alloim- mune thrombocytopenia. New England Journal of Medicine. 1997; 337(1):22-6. [DOI:10.1056/NEJM199707033370104] [PMID]
[33] Spencer JA, Burrows RF. Feto-maternal alloimmune thrombo- cytopenia: A literature review and statistical analysis. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2001; 41(1):45-55. [DOI:10.1111/j.1479-828X.2001.tb01293.x] [PMID]
[34] Tiller H, Kamphuis MM, Flodmark O, Papadogiannakis N, David AL, Sainio S, et al. Fetal intracranial hemorrhage caused by fetal and neonatal alloimmune thrombocytopenia: An observational cohort sudy of 43 cases from an international multicenter registry. BMJ Open. 2013; 3(3):e0024490. [DOI:10.1136/bmjopen-2012-002490] [PMID] [PMCID]
[35] van den Akker ESA, Oepkes D, Lopriore E, Brand A, Kanhai HHH. Non-invasive antenatal management of fetal and neonatal alloim- mune thrombocytopenia: Safe and effective. BJOG: An Interna- tional Journal of Obstetrics & Gynaecology. 2007; 114(4):469-73. [DOI:10.1111/j.1471-0528.2007.01244.x] [PMID]
[36] Berkowitz RL, Kolb EA, McFarland JG, Wissert M, Primani A, Lesser M, et al. Parallel randomixzed trials of risk-based therapy for fetal alloimmune thrombocytopenia. Obstetrics & Gynecology. 2006; 107(1):91-6. [DOI:10.1097/01.AOG.0000192404.25780.68] [PMID]
[37] Rayment R, Brunskill SJ, Sothilll PW, Roberts DJ, Bussel JB, Murphy MF. Antenatal interventions for feto-maternal alloimmune thrombocyto- penia. Cochrane Database of Systematic Reviews. 2011;(5):CD004226. [DOI:10.1002/14651858.CD004226.pub3] [PMID]
[38] van der Lugt NM, Kamphius MM, Paridaans NPM, Figee A, Oepkes D, Walther FJ, et al. Neonatal outcome in alloimmune thrombocyto- penia after maternal treatment with intravenous immunoglobulin. Blood Transfusion. 2015; 13(1):66-71. [DOI:10.2450/2014.0309-13] [PMID][PMCID]
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| Issue | Vol 6 No 6 (2021): November-December | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v6i6.9174 | |
| Keywords | ||
| Fetal-neonatal alloimmune thrombocytopenia Intracranial hemorrhage Subdural hematoma | ||
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How to Cite
1.
Abiri A, Saleh M, Shabani A. Antenatally Diagnosed Fetal Subdural Hematoma: A Case Report. CRCP. 2022;6(6):259-264.
