Fetal brain lactate peak measurement by magnetic resonance spectroscopy for prediction of fetal hypoxia in a case of unexplained third trimester recurrent fetal loses

Abstract

Fetal brain lactate peak measurement by magnetic resonance spectroscopy for prediction of fetal hypoxia in a case of unexplained third trimester recurrent fetal loses B. Akar 1 , R. Aslancan 2 , H. Şimşek 3 , P. Çakır 4 , E. Çalışkan 5 1İstinye University School of Health Sciences, Istanbul; 2Bahcesehir University School of Medicine, Istanbul 3Sakarya Eğitim Araştırma Hastanesi, Adapazarı; 4Derince Eğitim ve Araştırma Hastanesi, Kocaeli 5Department of Obstetrics and Gynecology, Bahcesehir University School of Medicine, Istanbul (Turkey) Summary Background: The fetal brain lactate level which is measured by magnetic resonance spectroscopy (MRS) is a compelling indicator for hypoxic/ischemic brain damage. Aim: The authors present a case of MRS diagnosed fetal brain lactate peak despite normal fetal development and Doppler indices which lead to a preterm delivered hypoxic fetus. Case Report: A 37-year-old woman admitted to this clinic at 30 weeks six days of her gestation because of previous recurrent three unexplained fetal death at third trimester and one neonatal death. At 33 weeks one day of pregnancy, MRS examination showed lactate peak in the fetal brain, despite bi-weekly normal Doppler indices and fetal biophysical profile follow-up. After eight days of daily follow-up since lactate peak measurement, her biophysical profile was 6 despite normal Doppler indices. She developed mild preeclampsia after four days following lactate peak. She had imminent cesarean section at 34 th week of gestation and a 1,980-gram neonate with Apgar scores of 5 and 7 at the first and fifth minute was delivered. Fetal hypoxia was diagnosed due to base excess of -14 and a cord blood pH of 7.16. The newborn was discharged in a healthy state after five days of neonatal intensive care. Conclusion: The case presents that fetal brain lactate peak can be the only first warning sign in cases of unexplained fetal losses predicting oncoming fetal hypoxia despite normal fetal Doppler and biophysical profile evaluation.