Ultrasound and Doppler imaging
findings in a 37 weeks pregnancy:
1. Umbilical Artery Doppler: Resistance Index (RI) of 0.69
2. Middle Cerebral Artery (MCA) Doppler: RI of 0.65
3. CPR = MCA RI / Umbilical Artery RI = 0.94 (reversed CPR)
Significance:
- A reversed CPR indicates a potential issue with fetal circulation.
- The increased resistance in the umbilical artery suggests reduced placental perfusion.
- The lower resistance in the middle cerebral artery indicates fetal brain sparing.
- These findings suggest fetal distress and potential compromise.
- In this case, the Doppler waveform of the Middle Cerebral Artery (MCA) shows a notable feature:
- Mild Increased Diastolic Flow: This indicates that during the diastolic phase of the cardiac cycle (when the heart is at rest and filling with blood), there is a higher-than-normal blood flow in the MCA.
This finding suggests that the fetal brain is compensating for the reduced placental perfusion indicated by the reversed cerebroplacental ratio (CPR). The increased diastolic flow in the MCA is a protective mechanism to ensure that the baby's brain receives an adequate supply of oxygen and nutrients, even when the placental circulation is compromised. It signifies fetal brain sparing and is an important indicator for assessing the well-being of the fetus in cases of uteroplacental insufficiency.
Prognosis and Management:
1. Continuous fetal monitoring is essential to assess the baby's well-being.
2. Consultation with a maternal-fetal medicine specialist is crucial.
3. Depending on the severity, early delivery may be necessary to prevent further complications.
4. If the fetus is not in distress, close monitoring with repeated Doppler studies is an option.
5. The management plan should be individualized based on the specific clinical context and findings.
Timely and appropriate management is vital to ensure the best possible outcome for both the mother and the baby.
(Images in this case are courtesy of Dr Golam).
For more on this topic visit:
Also available in India this ebook will be useful:
An ebook on arterial Doppler in atlas format
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