OC02.01: Office sonovaginography for the prediction of deep infiltrating endometriosis

Objectives: Cerebral white matter injury, consisting primarily of periventricular leukomalacia (PVL) and periventricular hemorrhagic infarction (PVHI) is well-described in premature infants. However, typical lesions of PVL and PVHI are uncommonly reported during fetal life. Recognition of abnormalities in the intermediate zone and subplate zone could allow the diagnosis of white matter injury during the intrauterine life. The purpose of this study is to identify prenatal imaging features of PVL and PVHI in the fetus and to assess associated risk factors. Methods: Institutional ethical approval was obtained to review prenatal sonographic and MRI records to identify fetuses with findings suggestive of PVL and PVHI. Correlation was made with postnatal imaging, clinical, and/or autopsy findings. Fetuses with intrauterine infection were excluded. Results: A total of 38 fetuses were identified by abnormal prenatal neurosonography and/or fetal MRI. Evidence of intracranial hemorrhage was present in 14/38 fetuses. PVHI was identified in 6 fetuses with intraventricular hemorrhage. PVL was present in 24. In 16/24 fetuses, PVL was extensive and diffuse. Complications of monochorionic twinning were present in 6, and hydrops fetalis was present in 6. Eight fetuses had focal PVL, and 3 of these were associated with demise of a monochorionic co-twin. Metabolic disorders and evidence of intracranial hemorrhage were identified in 2 fetuses. Exposure to teratogens known to be associated with brain injury occurred in 2/8 fetuses. Four fetuses had focal periventricular white matter defects; these were associated with severe intraventricular hemorrhage and presentation late in the third trimester. Conclusions: Targeted neurosonography provides high-resolution imaging of the fetal brain and is effective in identifying fetuses with abnormal white matter from a variety of etiological insults. This is primarily accomplished by evaluating abnormalities in transient laminar patterns in the developing white matter of the fetal cerebrum, with or without intracranial hemorrhage.