DR. E. SHILPALAKSHMI PRASAD,DR. SHANTHI E,DR. SWARNA PRIYA
DOI: https://doi.org/Background:
Key Doppler ultrasound metric used to evaluate fetal well-being, especially in high-risk pregnancies, is the cerebroplacental ratio (CPR). Abnormal CPR, particularly reversed flow, is often linked to fetalanemia, intrauterine growth restriction (IUGR), or placental insufficiency, usually requiring immediate delivery. Rare diseases such fetal arteriovenous malformations (AVMs), on the other hand, may change Doppler hemodynamics as well, which might cause misdiagnosis and unwarranted obstetric procedures.
Case Presentation
Routine prenatal care was done on a 23-year-old primigravida with Rh-negative blood type. Though no appropriate records were found, an outside centre had conducted an anomaly scan. A Doppler scan done at our hospital at 37 weeks revealed an unusually high CPR with a middle cerebral artery (MCA) Doppler index more than 3.4 MoM, which raised questions about fetalanemia. A specialist radiological scan showed a cerebral AVM on one side, changing patterns of cerebral blood flow. Expectant management was selected after counselling. At 39 weeks, the patient vaginally gave birth to a healthy girl baby. Postnatal MRI verified an AV fistula or vein of Galen abnormality; correction surgery was scheduled at six months of age.
Discussion:
This instance emphasizes the need of differentiating between fetalanemia and unusual vascular abnormalities including AVMs when aberrant CPR results are found. Misunderstanding AVMs could cause them to resemble placental insufficiency and result in unwarranted treatments. This instance further underlines that AVMs may not necessarily need cesarean section, since vaginal birth was successfully accomplished.
Conclusion:
Accurate diagnosis when aberrant Doppler results arise depends on expert imaging, so Optimal perinatal care is guaranteed by a multidisciplinary approach, hence avoiding misdiagnosis and needless treatments.
