Successful Vaginal Delivery in a Primigravida with Late-Onset Fetal Growth Restriction and Abnormal Cerebroplacental Ratio

Abstract

Fetal Growth Restriction (FGR) is a major cause of perinatal morbidity and mortality and is commonly associated with placental insufficiency. Appropriate intrapartum decision-making remains crucial in pregnancies complicated by late-onset FGR, particularly when Doppler abnormalities are present despite reassuring fetal surveillance. This case report describes a 25-year-old primigravida who presented in spontaneous labour at 38 weeks and 1 day of gestation. Obstetric ultrasonography with Doppler revealed late-onset FGR with an estimated fetal weight of 2451 g (3^rd percentile), abdominal circumference below the 2^nd percentile, and a reduced cerebroplacental ratio, while the umbilical artery demonstrated preserved forward end-diastolic flow. The biophysical profile and intrapartum cardiotocography remained reassuring throughout labour. Based on the overall fetal assessment, labour was managed expectantly under continuous maternal and fetal surveillance, resulting in spontaneous vaginal delivery of a healthy female neonate weighing 2.1kg with APGAR scores of 7, 8 and 9 at one, five and ten minutes, respectively. The newborn did not require neonatal intensive care unit admission, and both mother and baby were discharged in stable condition on the third postpartum day. According to Ayurvedic principles, impaired fetal growth may be conceptually correlated with Garbha Alpavridhi (restricted fetal growth), resulting from inadequate Garbha Poshana (fetal nourishment). This case emphasizes that an abnormal cerebroplacental ratio alone should not be considered an indication for cesarean delivery and highlights the importance of individualized obstetric management in achieving favourable maternal and neonatal outcomes.