Background. Fetal intracranial injury is a potentially devastating sequelae of maternal trauma, but there is little guidance regarding\nfetal evaluation in this setting. Case. A 23-year-old woman at 27-week gestation was admitted after a high-speed motor vehicle\naccident. The initial obstetrical ultrasound was unremarkable, but persistently minimal fetal heart rate variability was observed.\nUltrasound on day 3 after the accident showed an intracranial hyperechogenic lesion and subdural fluid collection. The neonate,\nfollowing an uneventful birth at 39 weeks, had seizures and abnormal muscle tone. MRI was consistent with in utero intracranial\nhemorrhage. Conclusion. Serial fetal imaging following maternal trauma, particularly when accompanied by abnormal fetal heart\nrate tracings, should be considered when fetal injury is a concern, even in the setting of a normal initial ultrasound.
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