A 30-year-old woman at 32 weeks gestation with severe early onset fetal growth restriction has Doppler studies showing absent end-diastolic flow in the umbilical artery and abnormal ductus venosus waveform. Abnormal ductus venosus flow in this setting indicates which pathophysiological event?

• A Fetal cardiac decompensation with raised central venous pressure ✓
• B Maternal anaemia
• C Placental infarction limited to the maternal surface
• D Normal adaptation to chronic hypoxia

Explanation

In placental insufficiency, rising placental resistance first abolishes then reverses umbilical arterial end-diastolic flow. As fetal hypoxia progresses, acidosis impairs myocardial compliance and raises central venous pressure, producing abnormal ductus venosus waveforms such as reduced or reversed flow during atrial contraction. This reflects late stage fetal cardiac decompensation and is an indication for delivery regardless of gestational age. Maternal anaemia and placental infarction do not directly produce ductus venosus waveform changes.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.