Management of 35-Week Fetus with Absent Fetal Movement and Absent Mean Sacral Velocity
Cesarean section (CS) is the recommended management for a 35-week fetus with no fetal movement and absent mean sacral velocity (MSV), as these findings indicate severe fetal compromise requiring immediate delivery. 1, 2
Immediate Clinical Assessment
The combination of absent fetal movement and absent MSV at 35 weeks represents critical fetal compromise that mandates urgent intervention rather than expectant management or labor induction. 1, 2
Why Cesarean Section is Indicated
Absent end-diastolic velocity (AEDV) indicates severe placental insufficiency with obliteration of approximately 70% of placental tertiary villi arteries, strongly associated with adverse outcomes including fetal demise and developmental disorders. 2
The Society for Maternal-Fetal Medicine recommends delivery at 33-34 weeks for FGR with AEDV, and since this patient is already at 35 weeks, delivery should not be delayed. 2
Cesarean delivery should be strongly considered for pregnancies with FGR complicated by absent/reversed end-diastolic velocity based on the complete clinical scenario. 3, 1, 2
Studies report rates of intrapartum fetal heart rate decelerations requiring cesarean delivery in 75-95% of pregnancies with FGR and AEDV, making primary cesarean section the safer approach. 1
Why NOT Expectant Management
Expectant management is contraindicated when fetal compromise is already established, as the risk of intrauterine fetal demise is unacceptably high with AEDV. 2
The absence of fetal movement combined with absent MSV indicates the fetus has already progressed beyond the surveillance phase into acute compromise. 1, 2
Why NOT Oxytocin/Labor Induction
Induction of labor is contraindicated in a fetus demonstrating severe compromise, as evidenced by absent Doppler flow in the setting of growth restriction. 1
Labor contractions would worsen placental perfusion and accelerate fetal deterioration in the context of severe placental insufficiency. 1
FGR fetuses with abnormal Dopplers are at increased risk for intrapartum metabolic acidemia and emergency cesarean delivery, making planned cesarean section preferable to attempted vaginal delivery. 1
Pre-Delivery Preparations
Coordination with neonatology is crucial for optimal resuscitation planning in cases of FGR with absent end-diastolic flow. 2
Preparation for potential neonatal complications including respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage is essential. 2
While antenatal corticosteroids are recommended for deliveries before 33 6/7 weeks or between 34 0/7 and 36 6/7 weeks, at 35 weeks the benefit is limited but should be considered if not previously administered. 3, 2
Critical Pitfall to Avoid
The most dangerous error would be attempting vaginal delivery or delaying intervention with expectant management when the fetus is already demonstrating severe compromise through absent fetal movement and absent MSV. 1, 2