Management of Reversed End Diastolic Flow

Introduction to Management

• The American College of Obstetricians and Gynecologists recommends delivery at 30-32 weeks of gestation for pregnancies with fetal growth restriction and reversed end-diastolic flow in the umbilical artery, as long as fetal surveillance remains reassuring 1, 2

Surveillance Protocol

• Hospitalization is recommended when reversed end-diastolic flow (REDF) is detected in the umbilical artery, with heightened surveillance using cardiotocography (CTG) at least 1-2 times per day 1
• Doppler assessment should be increased to 2-3 times per week when abnormal umbilical artery flow is detected, in pregnancies with suspected intrauterine growth restriction (IUGR) 1, 3

Antenatal Interventions

• Antenatal corticosteroids should be administered if reversed end-diastolic flow is noted at <34 weeks in a pregnancy with suspected intrauterine growth restriction (IUGR), with a Level I evidence, level A recommendation 4, 5, 1
• Magnesium sulfate for fetal neuroprotection should be administered if delivery is planned before 32 weeks gestation, in pregnancies with fetal growth restriction and reversed end-diastolic flow 1

Timing of Delivery

• Delivery at 30-32 weeks of gestation is recommended for pregnancies with fetal growth restriction and reversed end-diastolic flow, with a Level 1B recommendation according to the Society for Maternal-Fetal Medicine 5, 1, 2

Mode of Delivery

• Cesarean delivery should be considered for pregnancies with fetal growth restriction complicated by reversed end-diastolic velocity, based on the entire clinical scenario, as recommended by the American College of Obstetricians and Gynecologists 1

Clinical Pitfalls to Avoid

• Failing to differentiate between absent end-diastolic flow (delivery at 33-34 weeks) and reversed end-diastolic flow (delivery at 30-32 weeks) should be avoided, with daily consultant involvement 1, 3
• Delaying administration of corticosteroids, which should be given promptly when REDF is detected before 34 weeks, is not recommended, according to the American College of Obstetricians and Gynecologists 5, 1