This case stresses the different varieties of presentation of placentomegaly , IUGR and doppler studies. Kindly go through last week’s case to appreciate the differences.
This was a 23 year old lady with h/o gravida 2 , para 0 , live , abortion 1 .
She came for a scan around 29 to 30 weeks of gestation . She had pregnancy induced hypertension detected 1 week ago .She had no history of hypertension during the earlier pregnancy , when the fetal loss had occurred after 3 months.
Her earlier scan done elsewhere 2 months before was reported as normal .
She had a thick placenta , but appears homogenous.
Biometric measurements show AC <2.3 %TILE
Umbilical artery P.I and R.I are high . The MCA / UMBILICAL arterial ratio is abnormal.
AFI appeared to be normal.
BPD , HC <10 % tile and AC is < 2.3 % tile .
AFI is normal .
But the doppler values are abnormal. Umbilical artery P.I. and R.I are > 95 % tile . MCA P.I. and R.I are lower .
The cerebroplacental ratio ( MCA/UA ratio ) is abnormally low -0.70 suggestive of utero placental insufficiency.
This patient was referred by her obstetrician to an institution for further management.
The following references might be of help.
Pulsatility index of the middle cerebral artery in normal fetuses –
The MCA PI decreased as gestational age advanced from 1.97 (SD 0.48) at 20 weeks to 1.15 (SD 0.18) at 37 weeks.
Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies.
Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n=15) and 46% of the severe (n=30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile.
Changes observed in Doppler studies of the fetal circulation in pregnancies complicated by pre-eclampsia or the delivery of a small-for-gestational-age baby. I. Cross-sectional analysis.