A RARE CASE: PERSISTENT REVERSE END DIASTOLIC FLOW (PREDF) IN FETAL MIDDLE CEREBRAL ARTERY DURING MID TRIMESTER IN PREGNANT PATIENT WITH CARDIAC DISEASE, PRECEDING POOR FETAL OUTCOME

Background- Persistent reverse end-diastolic flow (PREDF) in the fetal middle cerebral artery (MCA) is a rare but critical Doppler finding indicating severe fetal compromise. Normally, fetal cerebral circulation shows high resistance; during hypoxemia, impedance decreases to maintain cerebral perfusion through the brain-sparing effect. PREDF represents failure of this autoregulatory mechanism and reflects advanced hemodynamic deterioration. It is associated with conditions such as fetal growth restriction, fetalanemia, hydrops fetalis, intracranial hemorrhage, and hepatic abnormalities.

Materials and Methods- A 22-year-old pregnant woman with underlying cardiac disease was evaluated at 23 weeks and 3 days of gestation (as per LMP) using serial fetal Doppler ultrasonography.

Results- Doppler examination demonstrated PREDF in the MCA along with early fetal growth restriction, hydrops fetalis (ascites, pleural effusion, and subcutaneous edema), severe ventriculomegaly, cerebellar hypoplasia, porencephalic cystic changes, and significant oligohydramnios. Progressive fetal compromise was noted on follow-up scans. Conclusion- PREDF in the fetal MCA is an ominous late marker of fetal distress.Despite monitoring, the pregnancy resulted in intrauterine fetal demise, and a dead fetus was delivered vaginally at 29 weeks and 5 days of gestation. This case highlights the grave prognostic implication of PREDF, especially in high-risk pregnancies.