Lack of normalization of middle cerebral artery flow velocity prior to fetal death before 30th week of gestation: a report of three cases

In recent years, the investigation of flow velocity in the middle cerebral artery (MCA) has become critical to the clinical management of fetal growth restriction (FGR). The increase in end-diastolic flow velocity, leading to a reduction of the pulsatility index (PI), is a consequence of compensatory cerebral vasodilatation (brain-sparing effect) secondary to fetal hypoxia. According to some authors1–3, cerebral flow velocity may reveal important prognostic signs of imminent fetal death in the presence of a loss of compensatory vasodilatation. This feature is described only sporadically in cases followed up until intrauterine death, providing evidence that it is a late sign and therefore may represent a poor index in FGR management. We report our experience of three pregnancies complicated by severe FGR followed by fetal death between the 25th and the 29th weeks of gestation.