Past history of pre-eclampsia.
US at 21WG
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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.
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