A primigravida at 28 weeks with early-onset pre-eclampsia has fetal growth restriction. Umbilical artery Doppler shows reversed end-diastolic flow with abnormal ductus venosus waveform. Cardiotocography is still reactive. What does this Doppler finding signify?

• A Normal placental resistance requiring routine surveillance
• B Severe uteroplacental insufficiency with high risk of fetal decompensation, warranting urgent multidisciplinary decision on delivery ✓
• C Fetal cardiac arrhythmia requiring antiarrhythmic therapy
• D Isolated oligohydramnios requiring amnioinfusion

Explanation

Absent or reversed end-diastolic flow in the umbilical artery indicates critically raised placental vascular resistance and is a late sign of severe fetoplacental compromise, often preceding abnormal ductus venosus flow and stillbirth. In early-onset growth restriction it mandates intensive surveillance and timely delivery planning balancing gestational age against fetal deterioration. It is a Doppler marker of placental disease, not arrhythmia or oligohydramnios, and never represents a normal tracing.

Reference: Ian Donald's Practical Obstetric Problems, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.