Which uteroplacental finding on Doppler velocimetry is MOST predictive of imminent fetal compromise in early-onset severe pre-eclampsia before 34 weeks?
- A Elevated uterine artery pulsatility index with notching
- B Absent or reversed end-diastolic flow in umbilical artery
- C Ductus venosus a-wave reversal ✓
- D Middle cerebral artery peak systolic velocity above 1.5 MoM
Correct answer: C. Ductus venosus a-wave reversal
Explanation
Ductus venosus a-wave reversal reflects severely elevated right cardiac afterload and predicts imminent fetal acidaemia and death with the highest specificity among all Doppler parameters. Absent/reversed end-diastolic flow in the umbilical artery indicates severe uteroplacental insufficiency but ductus venosus changes represent end-stage fetal cardiovascular compromise. MCA PSV >1.5 MoM is used for fetal anaemia, not pre-eclampsia surveillance.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.