Positive Fetal Outcome Following Severe Early Onset FGR With Abnormal Flow Pattern in the Ductus Venosus

Background: Growth restriction of the fetus (FGR) is a major cause of perinatal death and, if present, has many perinatal complications at enhanced risk. Early FGR, in particular, presents staggering clinical challenges for management, as there are no uniform diagnostic criteria or best-practice procedures. The lack of data from clinical trials also makes it difficult to provide uniform management recommendations, leading to substantial variation in practice and outcomes. Case: This case report describes a healthy 30-year-old woman in her third pregnancy, who was diagnosed with severe early-onset FGR at 25 weeks after abnormal Doppler results, such as reversed a wave in the ductus venosus (DV) and anhydramnios. Despite these sinister signs, the patient was subjected to close surveillance and timely intervention, such as steroid therapy for fetal lung maturation and regular ultrasound evaluation. The pregnancy ended with an uneventful vaginal delivery at 36+4 weeks with a good neonatal outcome. Conclusion: The case underscores the need for individualized treatment and close surveillance in the management of early-onset FGR. The favorable outcome supports the fact that a reversed wave in the DV is not invariably a sign of significant fetal compromise but can also be a function of local vascular events. The case underscores the need for further research to better define therapeutic interventions and diagnostic criteria, particularly regarding the abnormal Doppler study.