A rare case of fœtal subdural hematoma in the 2nd trimester of pregnancy
Mis à jour : 26 nov 2019
The probable hypothesis of a subdural fluid collection objectified through ultrasound is that of a subdural hematoma. This situation often results in foetal death or birth with irreversible neurological sequelae. The foetal SDH is very rare and little known to the examiners, the ultrasound diagnosis is delicate, and the prognosis is reserved.
Foetal subdural hematoma, Neurological sequelae, Ethics, Economy
Context and objectives
The case of a 19-year-old primiparous and primigravity pregnant woman carrying a 24-week foetal mono-foetal pregnancy, in cephalic presentation with an echogenic oval image on the periphery of the skull exerting a mass effect on the structures brain.
The presentation is about demonstrating the difficulty of care in an ethical, religious and socio-economic context and confronting this situation with the scarcity of existing scientific data dealing with this type of case.
The weekly ultrasound follow-up at TVC Medical was confronted with that of operators from other centres of the Kinshasa City-Province for confirmation of diagnosis. A privileged psychological support of the patient was set up in view of the difficulties encountered.
The follow-up revealed a gradual resorption of the hematoma, from 65 mm to 26 mm, which is why the multidisciplinary team considered allowing the pregnancy to evolve with all the usual reserves: very explicit explanations to the family in their language maternal risk, namely that of a foetal death or permanent disability. This regular, close follow-up will continue for several months after birth.
Such cases present a significant maternal-foetal risk. They involve the fields of medicine, ethics, sociology and law. What would be the best attitude to adopt in the current state of legislation in the DRC?