Brownfoot F C, Cluver C A, Walker S P
Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Australia.
Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa.
Ultrasound. 2015 Aug;23(3):186-9. doi: 10.1177/1742271X15587600. Epub 2015 May 27.
Fetal persistent middle cerebral artery reversed end diastolic flow is a rare and ominous finding. Previous cases have been associated with intracranial hemorrhage, growth restriction, anaemia, and hepatic anomaly. Intrauterine demise or early neonatal death is a common outcome. We report the case of persistent middle cerebral artery reversed end diastolic flow in a well-grown fetus at 32 weeks' gestation resulting from acute, severe anaemia due to a large feto-maternal hemorrhage. An emergency cesarean section was performed and the neonate required advanced resuscitation and immediate blood transfusion. Postnatal magnetic resonance imaging confirmed a hemorrhagic parietal infarct and bilateral ischaemic changes in the basal ganglia. This provides further evidence that persistent middle cerebral artery reversed end diastolic flow in any fetus is an ominous finding warranting urgent diagnostic evaluation and/or delivery.
胎儿大脑中动脉舒张末期血流持续反向是一种罕见且预后不良的表现。既往病例与颅内出血、生长受限、贫血及肝脏异常有关。宫内死亡或早期新生儿死亡是常见结局。我们报告一例孕32周发育良好的胎儿出现大脑中动脉舒张末期血流持续反向的病例，其病因是急性、严重贫血，由大量胎儿-母体出血所致。急诊剖宫产术后，新生儿需要高级复苏及立即输血。产后磁共振成像证实顶叶出血性梗死及双侧基底节区缺血性改变。这进一步证明，任何胎儿出现大脑中动脉舒张末期血流持续反向都是预后不良的表现，需要进行紧急诊断评估和/或分娩。
