The risk of intraventricular hemorrhage (IVH) can be reduced by using

Ans. a (Vitamin K) (Ref. Williams Obstetrics 22nd/Ch. 29)INTRAVENTRICULAR HEMORRHAGEThere are four major categories of neonatal intracranial hemorrhage: subdural hemorrhage is usually the result of trauma. Subarachnoid hemorrhage and intracerebellar hemorrhage usually result from trauma in term infants but in preterm infants are commonly due to hypoxia. Periventricular-intraventricular hemorrhage results from either trauma or asphyxia in half of term infants but has no discernible cause in 25 percent of cases. In preterm neonates, the pathogenesis of periventricular hemorrhage is multifactorial and includes hypoxic-ischemic events, anatomical factors, coagulopathy, and many others.The severity of intraventricular hemorrhage can be assessed by ultrasound and computed tomography. Papile and colleagues (1978) devised the most widely used grading scheme to quantify the extent of the lesion and estimate prognosis.# Grade I--hemorrhage limited to the germinal matrix.# Grade II--intraventricular hemorrhage.# Grade III--hemorrhage with ventricular dilatation.# Grade IV--parenchymal extension of hemorrhage.Prevention and Treatment# Administration of corticosteroids at least 24 hours before delivery appears to prevent or reduce the incidence and severity of intraventricular hemorrhage.# The type of corticosteroid administered may be important. Although both betamethasone and dexamethasone cross the placenta in their active form, betamethasone has a longer half-life. This is because it has a larger volume of distribution and is cleared more slowly than dexamethasone# The efficacy of phenobarbital, vitamin K, vitamin E, or indomethacin in diminishing the frequency and severity of intracranial hemorrhage, when administered either to the neonate or to the mother during labor, remains controversial.# Magnesium sulfate may prevent the sequelae of periventricular hemorrhage.# It is generally agreed that avoiding significant hypoxia both before and after preterm delivery is of paramount importance. There is presently no convincing evidence, however, that routine cesarean delivery for the preterm fetus presenting cephalic will decrease the incidence of periventricular hemorrhage.