What is Your Diagnosis of this Fetus?

by | March 02, 2013 3:24 PM EST

This seems to be delivery based entirely on fetal welfare. Fetal testing would not help. Bed rest probably not and anti hypertensive mess would pron
Bably be worse. While not a perinatologisy I would give mom steroids and deliver. None of us can stop people from suing as we are the only nation that allows this. 31 week fetus should fare well

by Viorel Suciu-Lazar | December 30, 2012 12:27 PM EST

Hello.
I would like to join all you guys and give the same obvious answer: placental insufficiency in a case of pregnancy-induced hypertension (we all know the physiopathology) wich compromises the fetus causing IUGR and hypoxia;
I also agree that the fetus needs to be removed from this "hostile environment"via C-section in a tertiary centre, after corticoid treatment for lung maturation and handed over to NICU.
I still have a few uncertainties and it seems the opinions differ among health care providers around the globe. I'd very much like to hear yours.
In this case, how do we know just how severely this fetus is affected, how soon we need to extract it and what the long-term consequences are? Someone here said this is a precentralization state, but I'd like to politely contradict; the blood flow is already centralized, meaning the brain sparing effect (blood is diverted not only towards the brain, but also towards the suprarenal glands and the miocardium). Also of importance and not shown here is the Doppler assessment of the descending aorta, wich in this case would show an absent end-diastolic flow (blood flow to the peripheral organs is at minimum). Moving on to the assessment of the DV flow, we can see a reversed end-diastolic flow (negative "a" wave) wich in my opinion reflects a severely affected fetus (despite the fact that blood flow is diverted towards the miocardium via the coronary arteries, the fetus is in heart failure). Isn't it than just logical to conclude that despite the brain sparing effect, the brain, like the heart, is also failing (remember that muscle cells are much more resistant to hipoxia than nerve cells), meaning nerve cells are dying? How extensive is the neurological damage?
Does the antihypertension treatment give us just a window to reach lung maturity or is it wise to prolong the pregnancy as long as we can? How do you best monitor the fetal well-being? Biophysical profile (Manning)? Amniocentesis? Fetal blood sampeling? How about the patient? Continuing pregnancy means the risk of complicating the hypertensive disorder (HELLP, eclampsia, abruptio placentae, cronic hyeprtension, renal failure, etc)
In my opinion this fetus needs to be extracted via C-section as soon as the corticoid treatment is completed, because it is already growth-restricted (it will not gain any more weight), it is severly compromised (including neurological damage) and there is a high risk of materno-fetal complications with the "wait-and-see" approach.
Does anybody know what the long-term outcome is for such a fetus (experience, studies, publications)? Will parents sue us for waiting to long before exctraction or for extracting the fetus too soon, too premature?
Respectfully waiting for your comments.

by sabiha sadat | November 23, 2012 12:00 PM EST

IUGR WITH REVERSED DIASTOLIC FLOW IN UA and brain sparing effect in MCA...

by ANTONIS SOCRATOUS | September 20, 2012 1:11 PM EDT

Iugr with reversed flow in the ua and dv.low diastolic pressure at the brain(centralization of the fetal blood)

by NOR AMIZU JUSOH | August 16, 2012 11:40 PM EDT

iugr