A 28-year-old woman at 30 weeks with severe pre-eclampsia has been stabilized on labetalol and magnesium sulfate. Repeat biophysical profile score is 6/10, umbilical artery Doppler shows absent end-diastolic flow (AEDF). According to current guidelines, the most appropriate management is:

• A Continue expectant management until 34 weeks with twice-weekly Doppler surveillance
• B Administer corticosteroids and deliver at 32–34 weeks if AEDF persists beyond 48–72 hours
• C Administer corticosteroids and deliver within 24–48 hours regardless of gestational age ✓
• D Switch to oral methyldopa and continue expectant management until fetal lung maturity is confirmed

Explanation

Absent end-diastolic flow (AEDF) on umbilical artery Doppler in the context of severe pre-eclampsia at 30 weeks is an ominous sign indicating severely compromised placental perfusion with high risk of fetal acidosis and death. Current guidelines (ACOG, RCOG) recommend corticosteroids for lung maturity and delivery within 24–48 hours when AEDF is accompanied by severe maternal disease — expectant management is not appropriate when both maternal and fetal criteria for delivery coexist. Reversed end-diastolic flow (REDF) mandates even more urgent delivery. Option B incorrectly defers delivery; options A and D dangerously prolong pregnancy in a critically compromised situation.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.