261: Antenatal sonography in women with postpartum hemorrhage: report on a new sonographic marker

Młynarczyk, Małgorzata; Johnson, Jessica; Zhao, Yili; Porche, Lea; Romary, Letty; Asatryan, Alis; Berkley, Eliza; Abuhamad, Alfred

doi:10.1016/j.ajog.2014.10.307

Cited by 2 publications

(6 citation statements)

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“…[8] Hypoxemia is compensated by a central redistribution of blood flow, resulting in increased blood flow to the brain, heart, and adrenals; and decreased blood flow to the peripherals. [1,5] This mechanism allows preferential delivery of nutrients and oxygen to vital organs. Increased blood flow of MCA in doppler findings is characterized by a decrease in PI with manifestations of cerebral vasodilation as a response to fetal hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

“…The right and left cerebral arteries are the main branches of the Circulus Willis that originate from the carotid and vertebral arteries. [1] Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs which maintains the oxygen delivery to the brain. A decrease in impedance manifests with a decrease in cerebral arterial resistance which is an early marker of autoregulation in hypoxemic States.…”

Section: Introductionmentioning

confidence: 99%

“…[2] This redistribution is known as the brain-sparing effect and plays an important role in the adaptation of the fetus to the lack of oxygen. [1] Reverse end-diastolic flow in the MCA is a rare fetal condition and a terminal hemodynamic event. [3] PREDF of the MCA occurs as a result of increased intracranial or extracranial pressure or as a result of cerebral edema and severe hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

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Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

Setiawan¹,

Mose²,

Kharismawati³

et al. 2023

Preprint

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Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. The reverse end-diastolic flow in the middle cerebral artery is the terminal hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence happening due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, intrauterine growth restriction (IUGR), fetal anemia, and fetal hepatic abnormalities as leading problems to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by IUGR and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

Setiawan¹,

Mose²,

Kharismawati³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Middle cerebral arteries (MCAs) are the most accessible cerebral vessel in fetal Doppler examination because they carry 80% of cerebral blood flow. The right and left cerebral arteries are the main branches of the Circulus Willis that originate from the carotid and vertebral arteries [1]. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain.…”

Section: Introductionmentioning

confidence: 99%

“…A decrease in impedance manifests with a decrease in cerebral arterial resistance, which is an early marker of autoregulation in hypoxemic states [2]. This redistribution is known as the brain-sparing effect and plays an important role in the adaptation of the fetus to the lack of oxygen [1].…”

Section: Introductionmentioning

confidence: 99%

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

Setiawan,

Mose,

Kharismawati

et al. 2023

Medicina

View full text Add to dashboard Cite

Doppler findings of persistent reverse end-diastolic flow (PREDF) in a fetal middle cerebral artery (MCA) are a very rare sonographic finding and are a marker of poor fetal condition. This finding often leads to intrauterine fetal death or early neonatal death. Reverse end-diastolic flow in the middle cerebral artery is an advanced hemodynamic event. Fetal cerebral circulation normally has a high impedance; in the event of fetal hypoxemia, impedance decreases, resulting in the central redistribution of blood flow to vital organs, which maintains the oxygen delivery to the brain. Reverse flow in the middle cerebral arteries describes the loss of this autoregulatory process. PREDF is a sequence that occurs due to increased extracranial or intracranial pressure. Previous case reports mentioned intracranial hemorrhage, fetal growth restriction, fetal anemia, and fetal hepatic abnormalities as problems leading to PREDF. This condition presumably arises due to cerebral edema associated with severe hypoxemia. We reported Doppler findings of PREDF MCA in a 33-year-old female patient at 30 weeks gestation who was referred to the hospital with severe preeclampsia accompanied by fetal growth restriction and oligohydramnios. A cesarean section was performed due to severe preeclampsia and a low bishop score. Hypotheses on various etiologies and their association with intrauterine/neonatal death as well as the best management still require further investigation.

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261: Antenatal sonography in women with postpartum hemorrhage: report on a new sonographic marker

Cited by 2 publications

References 0 publications

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

Persistent Reverse End Diastolic Flow in Fetal Middle Cerebral Artery: A Rare Finding with Poor Outcomes

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