Reversed End-Diastolic Flow in the Middle Cerebral Artery Preceding Death in a Normally Grown Fetus

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Abstract
Reversed diastolic flow in the middle cerebral artery has been described as a terminal sign in the growth-restricted fetus. The implication of this in a normally grown fetus is unknown. Middle cerebral artery Doppler velocimetry was performed at 28 weeks of gestation in the setting of decreased fetal movement and a category 2 fetal heart tracing. The middle cerebral artery pulsatility index was elevated, and follow-up studies revealed reversed flow. The fetus had appropriate growth, with mild polyhydramnios and no signs of cardiomegaly, effusion, or hydrops. Fetal death was diagnosed 4 days later in the setting of extensive intracranial hemorrhage. Regardless of fetal growth, persistent reversed middle cerebral artery Doppler with an elevated pulsatility index may be a feature of impending death.

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