Fetal Growth Restriction and Absent End-Diastolic Flow Management

Indications for Immediate Delivery

The Society for Maternal-Fetal Medicine recommends delivery at 33-34 weeks of gestation for pregnancies with fetal growth restriction and absent end-diastolic velocity, and since the patient is already at 35 weeks, delivery should not be delayed 1
AEDV indicates severe placental insufficiency, representing obliteration of approximately 70% of placental tertiary villi arteries, and is strongly associated with severe fetal growth restriction and adverse outcomes including mortality and developmental disorders 2
The American College of Obstetricians and Gynecologists supports the recommendation for immediate delivery in cases of fetal growth restriction with absent end-diastolic flow, given the high risk of intrauterine fetal demise 1

For pregnancies with fetal growth restriction complicated by AEDV, cesarean delivery should be strongly considered based on the complete clinical scenario, as recommended by the Society for Maternal-Fetal Medicine 3, 4
The use of antenatal corticosteroids should already have been administered if this is a new diagnosis, though at 35 weeks the benefit is limited, according to the American College of Obstetricians and Gynecologists 3, 4, 5

Coordination with neonatology is crucial for optimal resuscitation planning in cases of fetal growth restriction with absent end-diastolic flow, as recommended by the Society for Maternal-Fetal Medicine 2
Preparation for potential neonatal complications, including respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage, is essential in the management of fetal growth restriction with absent end-diastolic flow 2

Cesarean delivery should be strongly considered for pregnancies with fetal growth restriction (FGR) complicated by absent or reversed end-diastolic velocity, based on the complete clinical scenario, as recommended by the American College of Obstetricians and Gynecologists 6
The administration of antenatal corticosteroids should be considered if not previously administered, even at 35 weeks, as recommended by the American College of Obstetricians and Gynecologists 6