The Prenatal Consult (Part IV)

This is part IV of a series of posts which also currently includes part I,  part II , and part III.
The first topic that I cover in my head to toe discussion of possible complications is Intraventricular  Hemorrhage (IVH). I start by reminding them of our discussion of developmental outcomes. I then state that one of the potential complications related to developmental outcome is IVH. Simply stated, IVH is bleeding in a particular area of the brain. At the center of the brain are several fluid filled chambers known as the ventricles. As a fetus develops in the womb, there is a network of very fragile capillary blood vessels called the germinal matrix which is located at the center of the two lateral ventricles. This network of blood vessels becomes hardier and less fragile as the fetus develops, and ultimately goes away by about 34 weeks gestation. The earlier during gestation that a baby is delivered, the higher the chances for IVH. It is also associated with some other factors such as the presence of infection and overall stability of the baby. We screen all babies less than ~ 32 weeks gestation with a head ultrasound at about a week to ten days of age.
When IVH occurs, it is graded in severity as grade I-IV. Grade I is limited to the germinal matrix, while grade II involves extension of blood into the ventricle. Grade III bleeding extends into the ventricle and causes dilation of this fluid filled space. Grade IV extends into the brain tissue itself. Grade III and IV hemorrhages may progress to a condition known as post-hemorhhagic hydrocephalus in which the flow of fluid in the ventricles is obstructed and they become markedly enlarged. Such a condition may require surgical intervention. In terms of prognosis, grade III and IV hemorrhages are associated with worse neurodevelopmental outcomes while grade I and II hemorrhages are not necessarily. The strongest preditor is the need for surgical treatment of post-hemorrhagic hydrocephalus. I always point out to parents, however, that a head ultrasound is not an IQ test. An abnormal one does not mean for sure that a child will be affected developmentally and a normal one doesn't mean that a child will have no neurodevelopmental problems.
At this point, I pause for questions before moving onto the topic of Retinopathy of Prematurity, a topic that I will post about later.