A 28-week Pregnant female presents with the fetal distress on examination and the test performed (MCA Doppler study) is given below. What should be the next step in management?
(b) Give steroid cover and monitor with doppler and BPP, and plan deliverv Ref: William \ Obstetrics, 24th ed.Doppler shows absent blood flow during diastole in the brain.* In the normal situation, the fetal MCA has a high resistance flow which means there is minimal antegrade flow in foetal diastole* In pathological states this can turn into a low resistance flow mainly as a result of the fetal head sparing theory* Paradoxically in some situations such as with severe cerebral oedema, the flow can revert back to a high resistance pattern when the pathology has not yet resolved - this is a very poor prognostic sign* In the above case, baby is having fetal distress and absent diastolic flow in MCA, so immediate delivery should be planned.But immediate delivery of the baby at 28 weeks will lead to high neonatal morbidity and mortality. There will be higher chances of RDS, NEC, IVH, hyperbilirubinemia, prolonged NICU stay of the baby, polycythaemia, neonatal death. So, steroid cover should be given, and baby should be monitored till Dexamethasone cover and then termination can be planned.
Immediate termination of pregnancy
Give steroid cover and monitor with doppler and BPP. and plan delivery.
Give steroid and take up for CS immediately
Go for normal vaginal delivery as baby is very small
Abortion