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. 2009 Jan 21:(1):CD007113.
doi: 10.1002/14651858.CD007113.pub2.

Regimens of fetal surveillance for impaired fetal growth

Rosalie M Grivell  1 , Lufee Wong, Vineesh Bhatia
Affiliations

Regimens of fetal surveillance for impaired fetal growth

Rosalie M Grivell et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Policies and protocols for fetal surveillance in the pregnancy where impaired fetal growth is suspected vary widely, with numerous combinations of different surveillance methods.

Objectives: To assess the effects of antenatal fetal surveillance regimens on important perinatal and maternal outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2008).

Selection criteria: Randomised and quasi-randomised trials comparing the effects of described antenatal fetal surveillance regimens.

Data collection and analysis: R Grivell and L Wong independently assessed trial eligibility and quality and extracted data.

Main results: One trial of 167 women and their babies was included. This trial was a pilot study recruiting alongside another study, therefore a separate sample size was not calculated. The trial compared a twice-weekly surveillance regimen (biophysical profile, nonstress tests, umbilical artery and middle cerebral artery Doppler and uterine artery Doppler) with the same regimen applied fortnightly (both groups had growth assessed fortnightly). There were insufficient data to assess this review's primary infant outcome of composite perinatal mortality and serious morbidity (although there were no perinatal deaths) and no difference was seen in the primary maternal outcome of emergency caesarean section for fetal distress. In keeping with the more frequent monitoring, mean gestational age at birth was four days less for the twice-weekly surveillance group compared with the fortnightly surveillance group. Women in the twice-weekly surveillance group were 25% more likely to have induction of labour than those in the fortnightly surveillance group. The risk ratio was 1.25 (95% confidence interval 1.04 to 1.50).

Authors' conclusions: There is limited evidence from randomised controlled trials to inform best practice for fetal surveillance. regimens when caring for women with pregnancies affected by impaired fetal growth. More studies are needed to evaluate the effects of currently used fetal surveillance regimens in impaired fetal growth.

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References

References to studies included in this review

    1. McCowan LME, Harding JE, Roberts AB, Barker SE, Ford C, Stewart AW. A pilot randomized controlled trial of two regimens of fetal surveillance for small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry. American Journal of Obstetrics and Gynecology. 2000;182(1):81–6. - PubMed

References to studies excluded from this review

    1. Sood AK. Vibroacoustic stimulation and modified fetal biophysical profile in high risk pregnancy. Journal of Obstetrics and Gynaecology of India. 2007;57(1):27–36.
    1. Williams KP, Farquharson DF, Bebbington M, Dansereau J, Galerneau F, Wilson RD, et al. Screening for fetal well-being in a high-risk population comparing the nonstress test with umbilical artery Doppler velocimetry: a randomized controlled trial. American Journal of Obstetrics and Gynecology. 2003;188:1366–71. - PubMed

Additional references

    1. Alfirevic Z, Neilson JP. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews. 1996;(Issue 4) [DOI: 10.1002/14651858.CD000073] - PubMed
    1. Baschat AA, Harman CR. Antenatal assessment of the growth restricted fetus. Current Opinion in Obstetrics and Gynaecology. 2001;13:161–8. - PubMed
    1. Baschat AA. Arterial and venous Doppler in the diagnosis and management of early onset fetal growth restriction. Early Human Development. 2005;81(11):877–87. - PubMed
    1. Baschat AA. Fetal growth disorders. High risk pregnancy management options. Saunders; Philadelphia: 2006.
    1. Breeze AC, Lees CC. Prediction and perinatal outcomes of fetal growth restriction. Seminars in Fetal and Neonatal Medicine. 2007;12(5):363–97. - PubMed

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