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Prenatal and postnatal neurological evaluation of infant from pregnancy complicated with IUGR and fetal hypoxia

A 34-year-old pregnant woman, grav 3, para 1, peur 0, non-smoker, with a history of renal infection and diagnosed cervical insufficiency was admitted to the hospital at 27 weeks of gestation (wg) because of asymmetric fetal intrauterine growth restriction (IUGR). At hospitalization the Doppler ultrasound examination showed fetal flow redistribution with increased brain perfusion, and absent end-diastolic flow of the umbilical artery indicating fetal hypoxia. We have shown that severe brain damage can develop despite the fetal blood flow redistribution and increased brain perfusion. Therefore, we applied our new prenatal neurological screening test which is based on specific fetal movement patterns and signs observed by four-dimensional ultrasound. According to total score the following subgroups are: abnormal (0-5), moderately deviant (6-13) and normal (14-19). Fetal score was from 13 to 14 placing the fetus in moderately deviant and/or normal subgroup. At 30 wg preeclampsia occurred and pregnancy was ended by an emergency caesarian section (infant weight: 940g, APGAR 10, 10). Postnatal ultrasound brain examination showed bilateral intraventrical hemorrhage gr II. Amiel Tisson's neonatal assessment test was repeated every 2 weeks until the end of hospitalization showing normal neurological status. General movements (GMs) by Hadders-Algra were assessed at preterm, writhing, and fidgety age and each time classified as normal-suboptimal GMs. With 15 months of life child is demonstrating normal neurodevelopment. Despite unfavorable intrauterine conditions, diagnosed IUGR and fetal hypoxia, this premature infant showed normal neurological development which was verified not only by postnatal tests but also with new prenatal neurological screening test.

four-dimensional sonography; fetal neurodevelopment; IUGR; fetal hypoxia

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