Doppler ultrasound for fetal assessment in high risk pregnancies

BACKGROUND Abnormal waveforms from Doppler ultrasound may indicate poor fetal prognosis. It is also possible that Doppler ultrasound could encourage inappropriate early delivery. OBJECTIVES The objective of this review was to assess the effects of Doppler ultrasound in high risk pregnancies on obstetric care and fetal outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA Randomised trials of Doppler ultrasound for the investigation of umbilical artery waveforms in high risk pregnancies compared to no Doppler ultrasound. DATA COLLECTION AND ANALYSIS Trial quality was assessed and data were extracted by both reviewers. Study authors were contacted for additional information. MAIN RESULTS Eleven studies involving nearly 7000 women were included. The trials were generally of good quality. Compared to no Doppler ultrasound, Doppler ultrasound in high risk pregnancy (especially those complicated by hypertension or presumed impaired fetal growth) was associated with a trend to a reduction in perinatal deaths (odds ratio 0.71, 95% confidence interval 0.50 to 1.01). The use of Doppler ultrasound was also associated with fewer inductions of labour (odds ratio 0.83, 95% confidence interval 0.74 to 0.93) and fewer admissions to hospital (odds ratio 0.56, 95% 0.43 to 0.72), without reports of adverse effects. No difference was found for fetal distress in labour (odds ratio 0.81, 95% confidence interval 0.59 to 1.13) or caesarean delivery (odds ratio 0.94, 95% 0.82 to 1.06). REVIEWER'S CONCLUSIONS The use of Doppler ultrasound in high risk pregnancies appears to improve a number of obstetric care outcomes and appears promising in helping to reducing perinatal deaths.

[1]  J. Drumm,et al.  Non-invasive measurement of human fetal circulation using ultrasound: a new method. , 1977, British medical journal.

[2]  J. Newnham,et al.  Doppler flow velocity waveform analysis in high risk pregnancies: a randomized controlled trial , 1991, British journal of obstetrics and gynaecology.

[3]  K. Maršál,et al.  Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms , 1995, Acta obstetricia et gynecologica Scandinavica.

[4]  H. Odendaal,et al.  The role of Doppler velocimetry in the management of high risk pregnancies , 1994 .

[5]  J. Spencer,et al.  Randomised controlled trial of doppler ultrasound screening of placental perfusion during pregnancy , 1992, The Lancet.

[6]  N. Johnson,et al.  Randomised controlled trial of cardiotocography versus umbilical artery Doppler in the management of small for gestational age fetuses , 1997, British journal of obstetrics and gynaecology.

[7]  J. Neilson,et al.  Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. , 1995, American journal of obstetrics and gynecology.

[8]  R. Pattinson,et al.  Umbilical Artery Resistance Index as a Screening Test for Fetal Weil-Being. II: Randomized Feasibility Study , 1991, Obstetrics and gynecology.

[9]  F. Stanley,et al.  Effects of frequent ultrasound during pregnancy: a randomised controlled trial , 1993, The Lancet.

[10]  K. Maršál,et al.  Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses , 1992, The Lancet.

[11]  Anita Connelly,et al.  UMBILICAL ARTERY FLOW VELOCITY WAVEFORMS IN HIGH-RISK PREGNANCY Randomised Controlled Trial , 1987, The Lancet.

[12]  I. Greer,et al.  The effect of introduction of umbilical Doppler recordings to obstetric practice , 1993, British journal of obstetrics and gynaecology.

[13]  P. Mcparland,et al.  Review article: Doppler blood flow in pregnancy , 1988 .

[14]  H. Bruinse,et al.  A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care. , 1994, American journal of obstetrics and gynecology.

[15]  J. Vles,et al.  Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial , 1997, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[16]  R. Lilford,et al.  Randomised comparison of routine versus highly selective use of Doppler ultrasound in low risk pregnancies , 1993, British journal of obstetrics and gynaecology.

[17]  M. Whittle,et al.  Screening for the compromised fetus: a randomized trial of umbilical artery velocimetry in unselected pregnancies. , 1994, American journal of obstetrics and gynecology.