Facharzt FMH Gynäkologie Und Geburtshilfe Practice Questions - Facharzt FMH Für Gynäkologie Und Geburtshilfe Spécialiste FMH En Gynécologie Et Obstétrique Exam

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A 32-year-old woman at 30+4 weeks of gestation in her first pregnancy is being monitored for early-onset fetal growth restriction (FGR). Fetal biometry shows an estimated fetal weight at the 2nd percentile. Umbilical artery (UA) Doppler ultrasound reveals absent end-diastolic flow (AEDF). Middle cerebral artery (MCA) Doppler demonstrates brain-sparing with a pulsatility index (PI) below the 5th percentile. Ductus venosus (DV) Doppler shows forward flow during atrial systole (positive a-wave). Computerized cardiotocography (cCTG) shows a short-term variability (STV) of 4.2 ms with no decelerations. According to ISUOG and TRUFFLE consensus guidelines, what is the most appropriate management plan?

Immediate emergency cesarean section within 2 hours without awaiting corticosteroid maturation Administer antenatal corticosteroids (betamethasone 12 mg IM, two doses 24 hours apart), hospitalize for daily cCTG and DV Doppler monitoring, aiming for delivery if DV a-wave becomes absent/reversed or cCTG STV drops <3.5 ms Outpatient weekly ultrasound surveillance with no indication for maternal corticosteroids since ductus venosus flow remains normal Immediate labor induction with vaginal misoprostol after administration of maternal intravenous hydration

Correct Answer:

Administer antenatal corticosteroids (betamethasone 12 mg IM, two doses 24 hours apart), hospitalize for daily cCTG and DV Doppler monitoring, aiming for delivery if DV a-wave becomes absent/reversed or cCTG STV drops <3.5 ms

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