WS12‐09Absent or reversed end diastolic flow: clinical implications

The acronym ared indicates two characteristic patterns of the Doppler Velocity Waveform (DVWF) namely the observation of absence (EDFA) or reverse (RF) blood flow in diastole. ARED flow are usually observed in fetuses presenting severe intrauterine growth restriction (IUGR) or sometime are concomitant to fetal abnormalities like hydrops. The fetal condition is always severely affected mainly by hypoxaemia and/or acidaemia but at different levels according to the two patterns that are observed. Usually in the literature ared cases are presented and discussed without making difference between the two possible conditions. This approach cannot be considered correct because large differences in many clinical aspects are evident when evaluating separately EDFA or RF in 94 cases observed in our Institute. Gestational age, mean birth weight are significantly lower while perinatal mortality rate and prevalence of handicaps among survivors are significantly higher in the group presenting RF as compared to EDFA cases. As a consequence the clinical management is also different. In case of EDFA the timing of the delivery should be taken into consideration but it is not always urgent. On the contrary when RF is observed intrauterine death has to be expected within few days. Therefore the delivery should be immediate at the first observation of RF. The critical point is that also applying this policy the prevalence of handicaps among survivors is very high (35%). As a consequence when facing those clinical condition a careful and complete information must be offered to the family before choosing, if no maternal indications are present, an aggressive management.