Management of Absent End Diastolic Flow in Fetal Monitoring

Surveillance Protocol for AEDF

The American College of Obstetricians and Gynecologists recommends daily cardiotocograph (CTG) monitoring to assess fetal well-being in pregnancies with absent end-diastolic flow (AEDF) in the umbilical artery before 34 weeks' gestation 1, 3
Twice weekly umbilical artery Doppler assessment is recommended to monitor for progression to reversed end-diastolic flow in pregnancies with AEDF 1, 3
Regular amniotic fluid volume assessment (twice weekly) is recommended for pregnancies with AEDF 1, 3
Daily discussion with the team consultant about the clinical situation is recommended for pregnancies with AEDF 1, 3

The Society for Maternal-Fetal Medicine recommends delivery at 33-34 weeks of gestation for pregnancies with fetal growth restriction (FGR) and AEDF 4, 5, 6
Delivery should be considered no later than 34 weeks gestation with AEDF, according to the American College of Obstetricians and Gynecologists 1, 2, 3
Earlier delivery may be indicated in cases of poor interval fetal growth, deterioration of sonographic variables, or abnormal cardiotocography in pregnancies with AEDF 1, 3, 4

The American College of Obstetricians and Gynecologists recommends administering prenatal corticosteroids for fetal lung maturation between 24+0 and 34+0 weeks gestation in pregnancies with AEDF 1, 3
Magnesium sulfate (MgSO4) for fetal neuroprotection should be administered if delivery is planned before 32 weeks gestation in pregnancies with AEDF 1, 3, 4, 5

Consultation with an experienced obstetrician or fetal medicine specialist is recommended, particularly in severe, preterm fetal growth restriction with AEDF 1, 3
Histopathologic examination of the placenta is strongly recommended in all cases where fetal growth restriction is diagnosed prenatally or at birth, according to the Society for Maternal-Fetal Medicine 1, 3

Delaying delivery beyond 34 weeks in cases of AEDF increases the risk of adverse outcomes, according to the American College of Obstetricians and Gynecologists 1, 3, 4
Managing AEDF cases without daily team consultant involvement is not recommended 1, 3
Failing to differentiate between AEDF and reversed end-diastolic flow can lead to inadequate management, as the latter requires earlier delivery (30-32 weeks) 1, 3, 4, 5