A woman with severe pre-eclampsia at 30 weeks is being managed expectantly. Which finding on Doppler velocimetry indicates the most severe fetal compromise mandating delivery regardless of gestational age?

• A Elevated systolic/diastolic ratio in umbilical artery
• B Absent end-diastolic flow in umbilical artery
• C Reversed end-diastolic flow in umbilical artery ✓
• D Decreased pulsatility index in middle cerebral artery

Explanation

Reversed end-diastolic flow (REDF) in the umbilical artery represents the most severe form of uteroplacental insufficiency, indicating that resistance in the placental circulation is so high that diastolic flow is reversed. REDF is associated with high perinatal mortality and mandates delivery. Absent end-diastolic flow is also serious but REDF is the most ominous finding.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.