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 we eks' gestation, who was longitudinally followed up until delivery by cesare an section 33 days later (31 + 5 weeks) due to severe decelerations in CTG. Longitudinal Doppler assessment of the umbilical artery (UA). the middle c erebral artery (MCA) and the main branch of thr right pulmonary artery (RPA ), the ductus venosus (DV) and the left coronary artery was compared to cli nical course and computerized CTG. At first presentation (day -33) increase d 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 r everse 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 initia lly (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 a rteries 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. Sh ort-term variability in computerized CTG was stable at 6 to 7 ms, except fo r 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 gestat ion despite detection of AED resp. REd in the UA a prolongation of pregnanc y 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 co ronary arteries. The role of increased resistance in the main branches of t he pulmonary arteries should be examined in the future.