IUGR (symmetrical)

Case contributed by Dr Fabien Ho

Presentation

Past history of pre-eclampsia.

Patient Data

Age: 25
Gender: Male
Ultrasound

US at 21WG

Severe IUGR with an estimated fetal weight barely reaching 239g at 21WG (usually approx 500g is expected at this term). All biometric parameters < 3rd percentile.
Pathological umbilical Doppler with reversed diastolic flow.
Middle cerebral artery Doppler remained normal, indicating a relative vasodilation to preserve brain from damage: vascular redistribution, with a cerebro-placental ratio < 1, RI MCA / RI umbilical <1.
Ductus venosus Doppler : A wave is flat, which reflects increased filling pressure in the right atrium.
Bilateral uterine Dopplers showed protodiastolic notch (not shown), which is a non relevant finding at this stage with obvious abnormal umbilical Doppler. 
Placenta had a round shape with poor basal surface area and echoic aspect.  

Case Discussion

Typical findings of a vascular IUGR which occured early in pregnancy, with already severe findings. In theory, US anomalies occur in the following order : Uterine notchs -> Asymmetrical IUGR -> Umbilical Doppler with high RI -> Fetal redistribution to preserve brain -> Brain growth not preserved : Symmetrical IUGR -> Reverse diastolic flow in umbilical cord -> Tricuspid insufficiency then elevated right atrium pressure : flat A wave on ductus -> cardiac failure -> intra uterine death. 

Identification of such situations is critical to properly monitor

  • maternal consequences on blood pressure and related CNS, kidney and liver disorders
  • fetal demise with Intrauterine fetal death

 

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Case information

rID: 59231
Published: 14th Apr 2018
Last edited: 18th Apr 2018
System: Obstetrics
Inclusion in quiz mode: Included
Institution: CHU de la Reunion

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