Severe early-onset FGR with absent end-diastolic flow — decision station

Decision station: severe early-onset FGR with AEDF and evolving pre-eclampsia. Tests the candidate's ability to admit and surveil, administer the corticosteroid and neuroprotection bundle, sequence the Doppler and cCTG monitoring, and reach a TRUFFLE-informed delivery decision with senior input. Includes assessor key and marking domains.

Prompt

A 30-year-old G2P1 woman at 29 weeks gestation has an estimated fetal weight on the 2nd centile with absent end-diastolic flow in the umbilical artery. Her blood pressure is 144/92 mmHg with 1+ proteinuria. You are the registrar on the antenatal ward; the consultant is on the phone and the fetal medicine consultant is 30 minutes away.

Station brief

Format. Decision and management station, approximately 12 minutes. You are the obstetric registrar on the antenatal ward with a consultant on the phone and fetal medicine 30 minutes away. A midwife and the woman's partner are present. The assessor will run the clock and feed new information. ^[1]

Candidate instruction. Stabilise and surveil, administer the corticosteroid and neuroprotection bundle, sequence the Doppler and cCTG monitoring, escalate to your consultant and fetal medicine, and reach a TRUFFLE-informed delivery decision. Verbalise your reasoning. ^[1]^[4]

References5Show

[1]Lees CC, Marlow N, van Wassenaer-Leemhuis A, et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial Lancet, 2015.PMID 25747582
[2]Frusca T, Todros T, Lees C, Bilardo CM; TRUFFLE Investigators Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe Am J Obstet Gynecol, 2018.PMID 29422211
[3]Ganzevoort W, Thornton JG, Marlow N, et al. Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials Ultrasound Obstet Gynecol, 2020.PMID 31125465
[4]Lees CC, Stampalija T, Baschat AA, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction Ultrasound Obstet Gynecol, 2020.PMID 32738107
[5]Martins JG, Biggio JR, Abuhamad A Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction Am J Obstet Gynecol, 2020.PMID 32407785

Severe early-onset FGR with absent end-diastolic flow — decision station

Station brief

References5Show

[1]Lees CC, Marlow N, van Wassenaer-Leemhuis A, et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial Lancet, 2015.PMID 25747582
[2]Frusca T, Todros T, Lees C, Bilardo CM; TRUFFLE Investigators Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe Am J Obstet Gynecol, 2018.PMID 29422211
[3]Ganzevoort W, Thornton JG, Marlow N, et al. Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials Ultrasound Obstet Gynecol, 2020.PMID 31125465
[4]Lees CC, Stampalija T, Baschat AA, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction Ultrasound Obstet Gynecol, 2020.PMID 32738107
[5]Martins JG, Biggio JR, Abuhamad A Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and management of fetal growth restriction Am J Obstet Gynecol, 2020.PMID 32407785