Fetal intracranial hemorrhage and maternal vitamin K deficiency induced by total parenteral nutrition: A case report

• Published in: Medicine (Baltimore) 2022-01, Vol.101 (1), p.e28434-e28434
• Main Authors: Lee, Subeen, Kim, Hyun Mi, Kang, Juyeon, Seong, Won Joon, Kim, Mi Ju
• Format: Article
• Language: English
• Subjects: Adult; Cesarean Section - adverse effects; Clinical Case Report; Female; Fetal Diseases; Humans; Infant, Newborn; Intestinal Obstruction - etiology; Intracranial Hemorrhages - etiology; Parenteral Nutrition, Total - adverse effects; Parenteral Nutrition, Total - methods; Pregnancy; Vitamin K - administration & dosage; Vitamin K Deficiency - complications
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000028434

Fetal brain hemorrhage is rare. It is caused mainly by maternal trauma or fetal coagulation disorder, but in some cases, vitamin K deficiency may be the cause. We describe the case of a pregnant woman with bowel obstruction who was susceptible to vitamin K deficiency due to oral diet restriction, decreased intestinal absorption, and limited intravenous vitamin K supplementation. After 18 days of intermittent total parenteral nutrition, acute onset of severe fetal brain hemorrhage developed. After acute onset of fetal brain hemorrhage, the patient underwent an emergency cesarean section at 25 + 3 weeks of gestation due to fetal non-reassuring fetal monitoring. The Apgar score at birth was 0/0, and despite cardiopulmonary resuscitation, neonatal death was confirmed. After the baby was delivered, we checked the maternal upper abdominal cavity and found a massive adhesion in the small bowel to the abdominal wall near the liver and stomach with an adhesion band. The adhesion band, presumably a complication of previous hepatobiliary surgery, appeared to have caused small bowel obstruction. Adhesiolysis between the small bowel and abdominal wall was performed. This case demonstrates that even relatively short-term total parenteral nutrition can cause severe fetal brain hemorrhage. Vitamin K supplementation is required for mothers who are expected to be vitamin K deficient, especially if they are on total parenteral nutrition for more than 3 weeks.