Traumatic Subdural Hemorrhage in One Fetus of a Twin Pregnancy A Case Report

BACKGROUND: In utero subdural hemorrhage (SDH) has not previously been reported in 1 fetus of a twin gestation. Postnatal reports of SDH have been associated with both traumatic and nontraumatic etiologies. CASE: A 19-year-old woman, G 1 P 0, presented with a diamniotic-dichorionic pregnancy at 29-6/7 weeks' gestation for a growth scan. The patient reported a history of 2 assault events with abdominal trauma around 2 weeks prior to the ultrasound. Fetus 2 was found to be breech with the head close to the anterior uterine wall. Ultrasound detected a large left subdural collection of mixed echogenicity, consistent with SDH, and right ventriculomegaly with encephalomalacia of the right occipital lobe. Biparietal diameter and head circumference were both transiently greater than the 95th percentile. Fetus 1 was cephalic with normal intracranial anatomy. At 35 weeks the patient presented with preterm labor and delivered by cesarean birth. Neonatal imaging confirmed the findings, but neurologic deficits were not identified in the neonatal period. MRI at 12 months showed resolution of the hemorrhage and stable cystic encephalomalacia involving the right parietal and occipital lobes, with associated ex vacuo porencephalic dilation of the right lateral ventricle. At 18 months of age the baby was able to ambulate with support, with no reported seizure. CONCLUSION: This antenatal diagnosis of SDH in a twin pregnancy is likely related to the reported abusive trauma to the patient, with discordant findings between the twins due to fetal position.