O&G Cases · Antenatal care — fetal surveillance
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.
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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]
References4ShowHide
- [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
- [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