Extensive Intracerebral Hemorrhage Involving Basal Ganglia and Frontal Lobe With Intraventricular and Subarachnoid Extension in a Triplet Pregnancy Following In Vitro Fertilization: A Case Report and Review

Triplet births, particularly those achieved by assisted reproductive technologies, entail markedly elevated maternal and fetal risks, including hypertensive diseases. Intracerebral hemorrhage is an uncommon but devastating complication during the postpartum period. The main aim of our work is to throw light on the association of intracerebral hemorrhage in pregnancy with severe consequences. We presented and compared similar cases. We present a rare case of a 34-year-old lady who was pregnant with triplets conceived by in vitro fertilization. She had a significant intracerebral hemorrhage 2 h post elective lower-segment cesarean section. Her blood pressure was normal during prenatal and perioperative periods. A postoperative hypertensive emergency (200/110 mmHg) resulted in neurological decline and seizure, necessitating urgent airway protection and neuroimaging. The MRI indicated a substantial intracerebral hemorrhage with intraventricular and subarachnoid extension. Neurosurgical procedures included external ventricular drainage and decompressive craniectomy. The patient exhibited modest neurological improvement throughout neurocritical care. This case shows that women who have triplets are at a greater risk of experiencing a serious increase in blood pressure after giving birth, even if they had normal blood pressure before. High-risk factors like advanced maternal age and the use of assisted reproductive technologies further increase the risk of triplet pregnancy. Our case highlights the importance of frequent blood pressure monitoring postpartum. Immediate neurological consultation and, if necessary, intervention followed by intensive neurocritical care are central to management for better outcomes for the patient. All healthcare teams need to be alert for possible complications from pregnancy, like intracerebral hemorrhage, especially in high-risk groups such as older patients with multiple pregnancies or those who have used assisted reproductive techniques.