FETAL GROWTH RESTRICTION: EARLY VS. LATE ONSET: A CASE-BASED DISCUSSION
Researchers & Contributors
Dr. Bela Bhatt
MBBS MD (Obs and Gyne) FICOG FMF (UK) Certified Sonologist
Consultant (Obstetrics and Gynecology and Fetal Medicine)
Dr Bela's Women's Hospital and Fetal Medicine Center
Mumbai, Maharashtra, India
Dr. Karunakar Marikinti
MD MNAMS (AIIMS-Delhi) CCST FRCOG (UK) MSc (Spain)
Department of Obstetrics and Gynecology
Consultant Reproductive Endocrinologist, Gynecologist and Obstetrician
WOW London
Cambridge, United Kingdom
Dr. Kuldeep Singh
MBBS FICMCH FICMU FAUI
Department of Ultrasound
Consultant
Dr Kuldeep's Ultrasound and Color Doppler Clinic
New Delhi, India
Case Videos
Video 1
Insonate the umbilical artery in a free loop of the umbilical cord.
Video 2
This is the umbilical artery flow velocity waveform. With advancing gestation, the diastolic flow increases. With increasing hypoxia, gradually the diastolic flow will decrease, indicating that the impedance is going to increase, leading to finally absent end-diastolic flow and then reversal of flow in diastole.
Video 3
This is the middle cerebral artery, which is a part of the circle of Willis. You can insonate either the proximal vessel or the distal vessel.
Video 4
This is the middle cerebral artery flow velocity waveform. The middle cerebral artery is a high-resistance circuit. With increasing hypoxia, there is a brain-sparing effect, meaning the diastolic flow to the middle cerebral artery increases. So, if the middle cerebral artery is less than the 5th percentile, it is abnormal. With the increasing brain-sparing reflex giving way, brain edema will develop, and, again, diastolic flow will decrease.