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Introduction: Late-onset intrauterine fetal growth restriction (IUGR) is a common pregnancy complication diagnosed in 5–10% of pregnant women worldwide. Under the impact of hypoxia, the fetus develops a protective mechanism of adaptive changes occurring in the cerebral circulation (“brain-sparing effect”). Materials and methods: We conducted detailed longitudinal Doppler examinations and the monitoring of the fetal condition in 53 IUGR fetuses. Doppler measurements of the pulsatility index in the fetal tibial (TA-PI), umbilical (UA-PI), and middle cerebral arteries (MCA-PI) were performed, and the cerebral placental ratio (CPR) was determined on a weekly basis from the 33rd week to the birth. Results: The longitudinal analysis showed a significant increase in the TA-PI. The UA showed a plateau, but no increase was detected near term. The MCA-PI and CPR showed a progressive decrease in values from inclusion to delivery. Our findings indicate that the increase in the TA-PI was the first sign of the aggravating state of the fetus with the changes registered from the 35th week. The parameters of the UA-PI did not show significant changes, while the MCA and CPR became abnormal later from the 37th week. Conclusions: These observations can serve towards the development of guidelines for detecting the deteriorating signs and intervention timing in IUGR during late pregnancies.

Background and Objectives: Intrauterine growth restriction (IUGR) is the term used to describe a fetus whose estimated weight is less than the 10th percentile of its age growth curve. IUGR is the second most common cause of perinatal death. In many cases there is a deficiency in the standardization of optimal management, prenatal follow-up and timing of delivery. Doppler examination is the most sensitive test that can assess the condition of the fetus and indicate fetal intrauterine hypoxia. Numerous studies of the fetal intrauterine state focus on the umbilical artery and the fetal cerebral blood vessels, while the peripheral arteries have so far received insufficient attention. Materials and Methods: We present a case of an IUGR fetus monitored with a non-stress test (NST) and a Doppler examination of the fetal arteries (tibial, umbilical, middle cerebral and uterine) and the ductus venosus. In this case the first early sign of fetal hypoxia was revealed by blood flow changes in the tibial artery. Results: We hypothesize that peripheral vascular changes (in the tibial artery) may more accurately reflect the onset of deterioration in the condition of the IUGR fetus, such that peripheral blood flow monitoring ought to be employed along with other techniques already in use. Conclusion: This paper describes the clinical presentation of an early detection of late IUGR hypoxia and claims that blood flow changes in the tibial artery signal the worsening of the fetus’s condition.