Reverse flow in the fetal middle cerebral artery

Abstract

I read with interest the article by Sepulveda et al. (Sepulveda W, Shennan AH, Peek MJ. Reverse end-diastolic flow in the middle cerebral artery: An agonal pattern in the human fetus. Am J Obstet Gynecol 1996; 174: 1645-7). They demonstrated a case of reverse end-diastolic flow in the middle cerebral artery and in the umbilical artery before death of the fetus. Failure of circulation can result from any pressure outside the brain (external artificial pressure, oligohydramnios1Jakobovits Á Jörn H Color Doppler sonographic studies of cerebral blood flow in oligohydramnios.Orv Hetil. 1993; 134: 2139-2142PubMed Google Scholar) or inside (hydrocephalus, cerebral edema, or hemorrhage2Jakobovits Á Jörn H Real time and color Doppler sonographic investigation in cases of fetal hydrocephaly and cerebral hemorrhage.Clin Neurosci. 1994; 47: 261-265Google Scholar). There was a progressive oligohydramnios in the authors' case too. Fetal outcome depends on the ground disease and the reversibility of the organic alterations caused by this disease. I have seen such fetuses and they died on the day of cesarean section or within a week. In another case the reversed flow was observed in the thirty-fourth week of gestation in a growth-restricted fetus. Five days later the fetus was delivered by cesarean section because of pathologic cardiotocographic findings. Apgar values were 5, 7, and 9 at 1, 5, and 10 minutes. A boy with a birth weight of 2020 gm was observed for some days in the intensive care unit. Further development was uneventful. Reversal of adaptation is a sign of high risk of death, but not necessarily. If the fetus is neurologically intact and viable, there is hope that it will live. Preterm delivery is lifesaving only in the case of a neurologically intact and viable fetus, but in the authors' study that was not the case, with the fetus weighing only 460 gm.