Outcomes of spontaneous antepartum fetal subdural hematoma: a case report

BACKGROUND: Fetal subdural hematoma diagnosed antenatally is an extremely rare condition associated with high rates of fetal mortality and long-term neurological morbidity. The underlying mechanisms are poorly understood, and early prenatal diagnosis remains challenging, especially in low-resource settings. The author describes two cases of antepartum fetal subdural hematoma diagnosed by ultrasound in a low-resource African setting, highlighting the diagnostic features, management challenges, and outcomes. CASE PRESENTATION: This paper discusses two Black African pregnant women aged 33 and 24 years with singleton pregnancies diagnosed with fetal subdural hematoma by ultrasound. Both cases presented between 28 and 32 weeks of gestation. Ultrasound revealed hyperechogenic, oval subdural masses exerting mass effect on cerebral structures, associated with signs of fetal anemia and reversed middle cerebral artery diastolic flow. Both patients were evaluated for potential underlying etiologies, including trauma, infections, coagulopathies, and vascular anomalies; however, the etiology could not be identified. In one case, intrauterine death occurred two days after diagnosis. In the second case, an intrauterine transfusion was attempted but resulted in stillbirth on the same day. These findings suggest a likely spontaneous origin of the hemorrhage. Magnetic resonance imaging was not available at the time of diagnosis. CONCLUSION: Antepartum fetal subdural hematoma is a rare and often fatal condition with limited therapeutic options once significant hemorrhage has occurred. Prenatal detection may not significantly alter outcomes in advanced cases. Further research is needed to better understand its etiology, improve early diagnosis, and explore potential management strategies.