Ominous Normalization of Middle Cerebral Artery Flow Velocity Waveforms Preceding Fetal Death: Case Report

Abstract

The loss of middle cerebral artery compensatory vasodilatation appears to be ominous in fetuses with absent end diastolic umbilical waveforms. The authors report a case with a loss of the ‘brain-sparing effect’ 24 h before fetal death. Current pathophysiological explanations are discussed.

Doppler study of the fetal vertebral and middle cerebral arteries in fetuses with normal and increased umbilical artery resistance indices

“…Therefore, Doppler anomalies during fetal growth restriction begin with increases of the umbilical artery RI and progress when cerebral flow RIs decrease. Subsequently, if this mechanism fails,18, 19 the venous Doppler anomalies reflect a progressive cardiac failure ending up with the deterioration of the biophysical profile 20, 21…”

Doppler Study of the Fetal Vertebral Artery in Small for Gestational Age Fetuses With Intrauterine Growth Restriction

“…Growth anomalies actually start with increases in the umbilical artery resistive index and progress when cerebral impedances decrease. Subsequently, if growth restriction gets worse, 27 , 28 the venous Doppler anomalies reflect progressive cardiac failure, ending with deterioration of the biophysical profile 29 , 30 31 , 32 .…”