Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review
Introduction: Fetal intracranial hemorrhage (ICH) is a rare but serious prenatal diagnosis. Predisposing factors include maternal trauma and fetal coagulation dysfunction. Maternal vitamin K deficiency has been described as an etiology. We present a case of maternal vitamin K deficiency associated w...
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doaj-6f13cf819d46450d899fd7f9578b57d82021-05-24T04:30:15ZengElsevierCase Reports in Women's Health2214-91122021-07-0131e00329Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature reviewMuhammad Abu-Rmaileh0Abigail M. Ramseyer1Lyle Burdine2Nafisa K. Dajani3College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of AmericaDepartment of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Corresponding author at: Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Arkansas for Medical Sciences (UAMS), 4301 West Markham St., Little Rock, AR 72205, United States of America.Department of Surgery, Division of Transplant Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of AmericaDepartment of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of AmericaIntroduction: Fetal intracranial hemorrhage (ICH) is a rare but serious prenatal diagnosis. Predisposing factors include maternal trauma and fetal coagulation dysfunction. Maternal vitamin K deficiency has been described as an etiology. We present a case of maternal vitamin K deficiency associated with fetal ICH after percutaneous biliary drain (PBD) placement in a complicated cholecystectomy with injury to the common bile duct. Case presentation: A 21-year-old woman, G2P1, presented at 23 weeks and 3 days of gestation with epigastric pain, nausea and vomiting. Right upper quadrant ultrasound diagnosed cholelithiasis. The patient was managed conservatively and discharged. She returned four days later, at 24 weeks of gestation, with worsening symptoms and ultrasound showing acute cholecystitis. She underwent laparoscopic cholecystectomy. Increasing bilirubin and imaging showed a transected biliary duct that required percutaneous biliary drain (PBD) placement. The patient was discharged and followed up at a high-risk obstetric clinic. Prenatal ultrasound showed bilateral ventriculomegaly with features of ICH. Maternal vitamin K deficiency was confirmed with PIVKA-II testing. The patient received vitamin K supplementation with normalization of the coagulopathy. Delivery occurred at 36 weeks of gestation via cesarean delivery after preterm premature rupture of membranes for fetal macrocrania. The neonate was discharged to a hospice. Discussion: Maternal and neonatal etiologies for ICH include malabsorption and coagulopathy. Maternal vitamin K deficiency should be considered when coagulopathy is present. This case highlights that maternal vitamin K deficiency due to biliary diversion and malabsorption increases the risk of fetal ICH, which impacts pregnancy and neonatal outcomes.http://www.sciencedirect.com/science/article/pii/S2214911221000473Vitamin KFetal intracranial hemorrhageVentriculomegalyCholecystitisFat-soluble vitamin deficiency |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Muhammad Abu-Rmaileh Abigail M. Ramseyer Lyle Burdine Nafisa K. Dajani |
spellingShingle |
Muhammad Abu-Rmaileh Abigail M. Ramseyer Lyle Burdine Nafisa K. Dajani Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review Case Reports in Women's Health Vitamin K Fetal intracranial hemorrhage Ventriculomegaly Cholecystitis Fat-soluble vitamin deficiency |
author_facet |
Muhammad Abu-Rmaileh Abigail M. Ramseyer Lyle Burdine Nafisa K. Dajani |
author_sort |
Muhammad Abu-Rmaileh |
title |
Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review |
title_short |
Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review |
title_full |
Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review |
title_fullStr |
Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review |
title_full_unstemmed |
Fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin K deficiency after biliary drain placement: A case report and literature review |
title_sort |
fetal intracranial hemorrhage associated with maternal coagulopathy and vitamin k deficiency after biliary drain placement: a case report and literature review |
publisher |
Elsevier |
series |
Case Reports in Women's Health |
issn |
2214-9112 |
publishDate |
2021-07-01 |
description |
Introduction: Fetal intracranial hemorrhage (ICH) is a rare but serious prenatal diagnosis. Predisposing factors include maternal trauma and fetal coagulation dysfunction. Maternal vitamin K deficiency has been described as an etiology. We present a case of maternal vitamin K deficiency associated with fetal ICH after percutaneous biliary drain (PBD) placement in a complicated cholecystectomy with injury to the common bile duct. Case presentation: A 21-year-old woman, G2P1, presented at 23 weeks and 3 days of gestation with epigastric pain, nausea and vomiting. Right upper quadrant ultrasound diagnosed cholelithiasis. The patient was managed conservatively and discharged. She returned four days later, at 24 weeks of gestation, with worsening symptoms and ultrasound showing acute cholecystitis. She underwent laparoscopic cholecystectomy. Increasing bilirubin and imaging showed a transected biliary duct that required percutaneous biliary drain (PBD) placement. The patient was discharged and followed up at a high-risk obstetric clinic. Prenatal ultrasound showed bilateral ventriculomegaly with features of ICH. Maternal vitamin K deficiency was confirmed with PIVKA-II testing. The patient received vitamin K supplementation with normalization of the coagulopathy. Delivery occurred at 36 weeks of gestation via cesarean delivery after preterm premature rupture of membranes for fetal macrocrania. The neonate was discharged to a hospice. Discussion: Maternal and neonatal etiologies for ICH include malabsorption and coagulopathy. Maternal vitamin K deficiency should be considered when coagulopathy is present. This case highlights that maternal vitamin K deficiency due to biliary diversion and malabsorption increases the risk of fetal ICH, which impacts pregnancy and neonatal outcomes. |
topic |
Vitamin K Fetal intracranial hemorrhage Ventriculomegaly Cholecystitis Fat-soluble vitamin deficiency |
url |
http://www.sciencedirect.com/science/article/pii/S2214911221000473 |
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