Fetal Middle Cerebral Artery Blood Flow Velocities in Pregnancies Complicated by Intrauterine Growth Restriction and Extreme Abnormality in Umbilical Artery Doppler Velocity

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Abstract
If they are not delivered in a timely fashion, pregnancies complicated by severe intrauterine growth restriction (IUGR) can lead to fetal loss. Conventional fetal well-being tests, including ultrasound measurement of fetal growth rate, biophysical profile, nonstress test, and contraction stress test are used to manage these pregnancies. Some fetuses delivered based on abnormal fetal well-being tests show long-term sequelae. A better understanding of the malfunction of the placenta and its effect on the fetus is desperately required for better management of these cases. We are reporting our experience of 6 such pregnancies followed by fetal middle cerebral artery (MCA) blood flow velocity measurements. There was significant decrease in MCA flow velocities in all of these fetuses compared to normal population (p < 0.05). Reverting to normal values occurred prior to the appearance of abnormal conventional tests, on average 4 days earlier. In other words, normalization of MCA flow velocities was a harbinger of fetal jeopardy. Although our observation includes a small number of patients, there is a potential for use of MCA blood flow velocity measurement to aid us in understanding and managing fetuses with IUGR. This needs to be evaluated in a larger study.

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