Longitudinal observation of deterioration of Doppler parameters, computerized cardiotocogram and clinical course in a fetus with growth restriction

We report on a fetus with intrauterine growth restriction detected at 27 weeks' gestation, who was longitudinally followed up until delivery by cesarean section 33 days later (31 + 5 weeks) due to severe decelerations in CTG. Longitudinal Doppler assessment of the umbilical artery (UA). the middle cerebral artery (MCA) and the main branch of thr right pulmonary artery (RPA), the ductus venosus (DV) and the left coronary artery was compared to clinical course and computerized CTG. At first presentation (day -33) increased resistance in both the UA and uterine arteries with bilateral notches was found. Absent enddiastolic flow (AED) in the UA was found at day -19 and reverse flow (RED) at day -11. The MCA showed a decreased pulsatility first at day -19 and again at day -11 together with RED in the UA. The RPA initially (day - 33) showed increased PI which returned to normal values at day -19 but increased again at day -1, when the DV showed RED and the coronary arteries became visible. The DV was normal until day -11, then its PI began to increase together with occurrence of RED in the UA, but reverse flow in the DV occurred only on the eve (day -1) of severe decelerations in CTG. Short-term variability in computerized CTG was stable at 6 to 7 ms, except for an intermediate drop to 4 ms at day -10. Maternal hypertension was found at day -19 and mild preeclampsia developed at day -12. A reduction of fetal movements was noticed at day -5. This report shows that at 29 weeks gestation despite detection of AED resp. REd in the UA a prolongation of pregnancy for 19 resp. 11 days is possible. in addition to abnormal CTG, late signs of fetal deterioration are reverse flow in the DV and visibility of the coronary arteries. The role of increased resistance in the main branches of the pulmonary arteries should be examined in the future.