Fetal subdural hematoma in a pregnant woman on low-dose aspirin: idiopathic or drug-induced?

backgroundFetal intracranial haemorrhage (ICH) is a rare antenatal complication that increases perinatal morbidity and mortality and may cause neurodevelopmental delay in surviving babies. Even though the majority of cases are idiopathic, there are many maternal and fetal factors predisposing to ICH. Low-dose aspirin (LDA) has a proven efficacy in secondary preeclampsia; however, with a daily dosage of > 100 mg, its safety is not well established and sporadic cases of fetal hemorrhagic complications have been reported. As fetal ICH has prognostic implications for the current and potentially for future pregnancies, in utero diagnosis is of utmost importance. CASE PRESENTATION: A 34-year-old primigravida was diagnosed with fetal subdural hematoma (SDH) on her routine third-trimester ultrasound (USG). There were no predisposing factors except that the patient was on LDA from the 12th week of gestation. The LDA was stopped at the 32nd week of gestation, and on serial USG, the SDH reduced in size. She delivered a healthy baby who was followed till 18 months of age and showed normal neurodevelopment.

conclusionsAs the number of reported cases of fetal ICH is limited, with even rarer SDH, meaningful etiological and prognostic criteria cannot be inferred, and parental counselling is challenging. The present case underscores the cautious patient selection and regular fetal monitoring in aspirin-treated pregnancies.