Management of SGA Fetus with Reversed End-Diastolic Flow

Rationale for Immediate Delivery

The American College of Obstetricians and Gynecologists recommends immediate delivery by caesarean section for SGA fetuses with reversed end-diastolic flow, with administration of antenatal corticosteroids if not previously given, hospitalization, and heightened fetal surveillance while preparing for delivery 1, 2
Reversed end-diastolic flow represents extreme placental insufficiency and mandates delivery without delay, although the specific guideline society is not specified in this instance 3, 4

For gestational ages ≥30-32 weeks, immediate delivery is recommended for FGR with reversed end-diastolic flow, as specified by guidelines from the American College of Obstetricians and Gynecologists 1, 2
For gestational ages <30 weeks, hospitalization with intensive surveillance is required, including daily cardiotocography, 3× weekly umbilical artery Doppler, and consideration of delivery based on the complete clinical picture, according to the American Heart Association 5, 1

Hospitalization with heightened surveillance, including cardiotocography at least 1-2 times daily, is necessary while preparing for delivery, as recommended by the American College of Obstetricians and Gynecologists 1, 2
Administration of antenatal corticosteroids between 24+0 and 34+0 weeks gestation is recommended, according to the American Heart Association 5, 1
Magnesium sulfate for fetal neuroprotection should be considered if <32 weeks gestation, as suggested by the American Heart Association 5, 1

The American College of Obstetricians and Gynecologists recommends cesarean delivery for pregnancies with FGR complicated by reversed end-diastolic flow, as these fetuses cannot tolerate the stress of labor contractions given the severe placental insufficiency 1, 2, 4

The American College of Obstetricians and Gynecologists advises against attempting labor induction or augmentation with reversed end-diastolic flow, as the fetus cannot tolerate uterine contractions given severe placental compromise 4
It is essential to distinguish reversed end-diastolic flow from absent end-diastolic flow, as reversed end-diastolic flow is more severe and requires earlier delivery, according to the American Heart Association 5, 1, 2
Cord arterial and venous pH should be obtained at delivery to assess the degree of fetal compromise, as recommended by the American Heart Association 5, 4
The placenta should be sent for histopathologic examination to guide future pregnancy management, according to the American Heart Association 5, 4