Doppler velocimetry study of maternal hemodynamics and fetal vascular pattern in a case of chronic hypertension with superimposed severe preeclampsia and impending fetal death.

A case is presented of chronic hypertension with superimposed severe preeclampsia; absence of end-diastolic velocity in the umbilical artery had been noted at gestational age of 20 weeks. Because the fetus was previable, the mother was treated with pharmacotherapy according to the maternal hemodynamics; uteroplacental circulation and fetal vascular blood flow were monitored by Doppler velocimetry. Deterioration of the fetal condition occurred during crossover of maternal hemodynamics from a low-resistance to a high-resistance state. Serial Doppler velocimetry studies done within 40 minutes of fetal death are described. There were two types of absent end-diastolic velocity in the umbilical artery, and the pathophysiology and clinical management may be quite a different in these two situations.