Abstract
Background: The fetal brain lactate level which is measured by magnetic resonance spectroscopy (MRS) is a compelling indicator for hypoxic/ischemic brain damage. Aim: The authors present a case of MRS diagnosed fetal brain lactate peak despite normal fetal development and Doppler indices which lead to a preterm delivered hypoxic fetus. Case Report: A 37-year-old woman admitted to this clinic at 30 weeks six days of her gestation because of previous recurrent three unexplained fetal death at third trimester and one neonatal death. At 33 weeks one day of pregnancy, MRS examination showed lactate peak in the fetal brain, despite bi-weekly normal Doppler indices and fetal biophysical profile follow-up. After eight days of daily follow-up since lactate peak measurement, her biophysical profile was 6 despite normal Doppler indices. She developed mild preeclampsia after four days following lactate peak. She had imminent cesarean section at 34 th week of gestation and a 1, 980-gram neonate with Apgar scores of 5 and 7 at the first and fifth minute was delivered. Fetal hypoxia was diagnosed due to base excess of -14 and a cord blood pH of 7.16. The newborn was discharged in a healthy state after five days of neonatal intensive care. Conclusion: The case presents that fetal brain lactate peak can be the only first warning sign in cases of unexplained fetal losses predicting oncoming fetal hypoxia despite normal fetal Doppler and biophysical profile evaluation.
Highlights
Antenatal follow up of fetal well-being has a crucial importance to prevent neonatal hypoxia caused by intrauterine complications
Intrauterine cerebral lactate peak is an indicator for fetal hypoxia which may cause intrauterine death so its diagnosis can help planning optimal delivery time or emergency cesarean section for fetal protection [35]
Most of the cases suggest that fetal brain lactate peak is present in the fetuses with intrauterine growth restriction (IUGR), and preeclamptic mothers [6, 7]
Summary
Antenatal follow up of fetal well-being has a crucial importance to prevent neonatal hypoxia caused by intrauterine complications. There are different methods used to evaluate fetal well-being, such as biophysical profile and fetal Doppler measurements In addition to these methods, magnetic resonance spectroscopy (MRS) is a recently proposed method to assess presence of brain lactate peak as an indicator of the manifestation of fetal hypoxia in the brain (Figure 1) [1]. Most of the cases suggest that fetal brain lactate peak is present in the fetuses with intrauterine growth restriction (IUGR), and preeclamptic mothers [6, 7] In this case report, a patient with three intrauterine unexplained fetal losses and one early neonatal loss was diagnosed to have fetal brain lactate peak by MRS as a first sign of fore coming fetal hypoxia and late onset preeclampsia during her present gestation
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