To report a case of warfarin-associated fetal intracranial hemorrhage and to analyze relevant clinical manifestations based on a literature review.

This study reported a case of warfarin-associated fetal intracranial hemorrhage who was admitted to Hong Kong University Shenzhen Hospital in 2020. Relevant articles were retrieved from China National Knowledge Infractructure, the Wanfang and the PubMed Database from their release dates to April 2021. Clinical manifestations and prognosis of warfarin-associated fetal intracranial hemorrhage were analyzed and discussed.

(1) Case report: a pregnant woman on long-term warfarin after mechanical heart valve replacement had an ultrasound examination at 29^{+ 1} week of pregnancy showing fetal ventriculomegaly. Fetal MRI showed intracranial hemorrhage. Warfarin was stopped and LMWH started at 31^{+ 1} gestational weeks. There was no progressive dilatation of the fetal lateral ventricles. The baby was delivered at 37^{+ 4} weeks and followed up to 11 months of age with abnormal movement of one limb.(2)Literature review: one Chinese and seven English articles were retrieved, including 11 cases. The 8 cases with poor perinatal outcomes were diagnosed late or had no clinical intervention after diagnosis. Three patients with a change in anticoagulant treatment or delivered early after diagnosis achieved better perinatal outcomes.

Warfarin-associated fetal intracranial hemorrhage is a rare fetal complication caused by warfarin anticoagulation during pregnancy, which often has a poor prognosis. It is important to conduct individualized management for pregnant women taking warfarin during pregnancy, fine-regulate the dose of warfarin and monitor the fetal condition by ultrasound. Early diagnosis and intervention are the key to improve the outcome of pregnancy.