Prediction of Imminent Jeopardy for Growth Restricted Fetus Using Handheld Fetal Doppler as A Viable Alternative in Resource Constrained Environment: A Case Report

Abstract

Intensive, and sometimes very expensive antenatal monitoring is often required in fetal growth restriction (FGR) to prevent prematurity and intrauterine jeopardy. This may not be feasible in a low resource setting. We report a 31-year-old gravida 3 para 2 +0. She had static fetal growth from 31weeks. Umbilical artery doppler velocimetry revealed a resistance index of 0.71. A week later, she complained of reduced fetal movement. On the real time and cardiograph modes of handheld fetal doppler, fetal heart rate of 151 to 153beats per minute, and almost straight-line fetal heart rate tracing (absent baseline variability) were obtained; imminent fetal jeopardy was suspected. She declined immediate abdominal delivery, despite adequate counselling. Four days later, she had an intrauterine fetal death and still birth with weight of 1.3kg and no obvious abnormality. Simple handheld doppler can be used to predict imminent death of a growth restricted fetus, in low resource setting.