Cardiotocographic and sonographic findings in two cases of antenatally diagnosed intrauterine fetal brain death

Abstract

Intrauterine fetal brain death is a rare cause of a fixed fetal heart rate pattern. Seven cases have been previously reported in the literature, but only two of them were diagnosed prenatally and all the newborns died soon after delivery. Two additional cases of antepartum diagnosis of intrauterine fetal brain death, managed expectantly, are reported. We had the unique opportunity to document progressive sonographic cerebral changes during the follow-up period, following the neurological event, while the fetus continued life and growth in utero. The cardiographic and sonographic findings suggesting intrauterine fetal brain death were a prolonged fixed fetal heart rate, even following a vibroacoustic and contraction stress test; an atonic fetus without breathing and body movement; and the appearance of hydramnios and the development of ventriculomegaly.

Fetal Movements During Fetal Brain Death-Like Status

“…Except the presence of fetal movements, the time course and outcomes of our current case are exactly the same as those in fetal brain death syndrome reported previously [1][2][3][4][5][6]. The clinical features of fetal brain death syndrome include fixing of FHR and loss of any fetal movements.…”

“…The clinical features of fetal brain death syndrome include fixing of fetal heart rate (FHR) without decelerations and loss of fetal movements [1][2][3][4][5][6]. The etiological mechanism is thought to be chronic or acute hypoxia, resulting from a pathological state such as a temporary disruption of umbilical blood flow.…”

“…However, it is unknown when the fetal brain damage occurs and how it progresses in fetal brain death syndrome. Recently, we have encountered a case of severe fetal brain damage, which is exactly the same as fetal brain death syndrome [1][2][3][4][5][6]. In the case with severe brain death-like status, however, fetal movements were observed until delivery.…”

Cerebral blood flow in a case of fetal brain death syndrome

“…The etiological mechanism is thought to be chronic or acute hypoxia, resulting from a pathological state such as a temporary disruption of umbilical blood flow 1,4,5 . However, it is unknown when the fetal brain damage occurs and how it progresses in fetal brain death syndrome.…”

Fetal brain death and Dandy–Walker malformation

“…The prenatal diagnosis of fetal brain death has been reported in only a few case studies (Adams, 1977;Nijhuis et al, 1988Nijhuis et al, , 1990Zimmer et al, 1992). The characteristic finding of fetal brain death is a fixed fetal heart rate (FHR) pattern and higher than normal baseline FHR in the range of 140-170 bpm.…”