Fetus-general

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1) Intrauterine fetal death (IUFD):

 

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Spalding sign for fetal death

These ultrasound images of the fetal skull reveal overlap of the bones of the calvarium following fetal demise. This is known as the Spalding sign and is diagnostic of intrauterine fetal death. Images courtesy Dr. Ravi Kadasne, UAE.

2) Color doppler imaging of fetal growth retardation (IUGR) and fetal hypoxia:

a) Doppler of umbilical artery:

doppler waveform of the umbilical artery     showing diastolic flow reversal in umbilical artery

 Color doppler and spectral waveform imaging of the umbilical artery shows reversal of diastolic flow. This is an ominous sign of fetal compromise/ hypoxia and requires us to evaluate the fetal middle cerebral artery and ductus venosus. The diastolic flow reversal in umbilical arteries signifies severe placental insufficiency and increased placental vascular resistance, which is bad news for the fetus.

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b) Doppler evaluation of the MCA (middle cerebral artery):

showing doppler waveform of the fetal cerebral artery     fetal MCA shows low resistance flow

Color doppler and spectral waveform of the middle cerebral artery shows increased diastolic flow in the fetal brain suggesting a "fetal brain sparing" effect, whereby, the fetal cerebral vessels "open up", lowering the cerebral vascular resistance to increase flow to the brain thus diverting blood to the important organs in a state of overall fetal hypoxia.

c) Doppler evaluation of the Ductus Venosus (DV):

locating the fetal ducus venosus     Doppler spectral waveform of the fetal ductus venosus

fetal ductus venosus shows diastolic flow reversal   

Doppler spectral waveform of the ductus venosus shows not just absent diastolic flow, but actual flow reversal during diastole. This is an ominous sign and suggest severe fetal compromise (ie: hypoxia). It is associated with very high fetal morbitidity and mortality. In this fetus, the Resistance Index for the vessels in this case are as follows:

Umb. Artery: 0.92 ;  MCA: 0.75;   DV: 0.99

The cerebro-placental ratio = RI (mca)/ RI (umb. a.) = 0.75/0.92 = 0.81.

The normal ratio is > 1. This suggests severe fetal growth retardation (IUGR) in this fetus possibly due to severe placental insufficiency. Ultrasound imaging and biometry also confirmed evidence of growth retardation in this fetus (28 weeks by ultrasound versus 31 weeks by Last Menstrual period). All these ultrasound and color doppler images suggest fetal growth reardation with fetal compromise and anoxia- meaning we have a very sick fetus that needs prompt delivery.

Images taken by Joe Antony, MD, using Toshiba, Nemio- XG Color doppler machine.

Reference: 1) http://medind.nic.in/jaq/t05/i2/jaqt05i2p138.pdf (significance of doppler evaluation in fetus).

2) http://www.jultrasoundmed.org/cgi/content/abstract/6/6/291 (abstract)

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  This page was last edited on: Wednesday September 17, 2008 02:35 PM  

Copyright ©   2007- All rights reserved- www.ultrasound-images.com Dr. Joe Antony, MD,    265, Girinagar, Cochin- 20, India.

Contact: joe@ultrasound-images.com or drjoea (at) gmail.com