title: Reversed end-diastolic flow in the middle cerebral artery preceding death in a normally grown fetus.
abstract: BACKGROUND
  Reversed diastolic flow in the middle cerebral artery has been described as a terminal sign in the growth-restricted fetus. The implication of this in a normally grown fetus is unknown.
  
  
  METHODS
  Middle cerebral artery Doppler velocimetry was performed at 28 weeks of gestation in the setting of decreased fetal movement and a category 2 fetal heart tracing. The middle cerebral artery pulsatility index was elevated, and follow-up studies revealed reversed flow. The fetus had appropriate growth, with mild polyhydramnios and no signs of cardiomegaly, effusion, or hydrops. Fetal death was diagnosed 4 days later in the setting of extensive intracranial hemorrhage.
  
  
  CONCLUSIONS
  Regardless of fetal growth, persistent reversed middle cerebral artery Doppler with an elevated pulsatility index may be a feature of impending death.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, Pennsylvania.
authors.forename: Adi
authors.initials: A
authors.lastname: Hirshberg
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Levine
authors.forename: Nadav
authors.initials: N
authors.lastname: Schwartz
authors.forename: Celeste P
authors.initials: CP
authors.lastname: Durnwald
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005324:Fetal Movement; D006340:Heart Rate, Fetal; D006801:Humans; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D018608:Ultrasonography, Doppler