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Meta-Analysis
. 2010 Jan 20:(1):CD007529.
doi: 10.1002/14651858.CD007529.pub2.

Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Zarko Alfirevic  1 , Tamara Stampalija, Gillian Ml Gyte
Affiliations
Meta-Analysis

Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Zarko Alfirevic et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Abnormal blood flow patterns in fetal circulation detected by Doppler ultrasound may indicate poor fetal prognosis. It is also possible false positive Doppler ultrasound findings could encourage inappropriate early delivery.

Objectives: The objective of this review was to assess the effects of Doppler ultrasound used to assess fetal well-being in high-risk pregnancies on obstetric care and fetal outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009) and the reference lists of identified studies.

Selection criteria: Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in high-risk pregnancies compared to no Doppler ultrasound.

Data collection and analysis: Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked.

Main results: Eighteen completed studies involving just over 10,000 women were included. The trials were generally of unclear quality with some evidence of possible publication bias. The use of Doppler ultrasound in high-risk pregnancy was associated a reduction in perinatal deaths (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.52 to 0.98, 16 studies, 10,225 babies, 1.2% versus 1.7 %, numbers needed to treat = 203; 95%CI 103 to 4352). There were also fewer inductions of labour (average RR 0.89, 95% CI 0.80 to 0.99, 10 studies, 5633 women, random effects) and fewer caesarean sections (RR 0.90, 95% CI 0.84 to 0.97, 14 studies, 7918 women). No difference was found in operative vaginal births (RR 0.95, 95% CI 0.80 to 1.14, four studies, 2813 women) nor in Apgar scores less than seven at five minutes (RR 0.92, 95% CI 0.69 to 1.24, seven studies, 6321 babies).

Authors' conclusions: Current evidence suggests that the use of Doppler ultrasound in high-risk pregnancies reduced the risk of perinatal deaths and resulted in less obstetric interventions. The quality of the current evidence was not of high quality, therefore, the results should be interpreted with some caution. Studies of high quality with follow-up studies on neurological development are needed.

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Figures

Figure 1
Figure 1. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
Figure 2
Figure 2. Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.1 Any perinatal death after randomisation
Figure 3
Figure 3. Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.8 Cesarean section (elective and emergency)
Figure 4
Figure 4. Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.9 Cesarean section - elective
Figure 5
Figure 5. Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.10 Cesarean section - emergency
See this image and copyright information in PMC

References

References to studies included in this review

    1. *

    2. Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, Ulmsten U, et al. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet. 1992;340:936–40. - PubMed
    1. Almstrom H, Axelsson O, Ekman G, Ingemarsson I, Maesel A, Arstrom K, et al. Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms. Acta Obstetricia et Gynecologica Scandinavica. 1995;74:526–9. - PubMed
    1. Marsal K, Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, et al. Umbilical artery velocimetry is more effective than cardiotocography for surveillance of growth retarded fetuses. Journal of Perinatal Medicine. 1991;19(Suppl 2):84.

    1. *

    2. Biljan M, Haddad N, McVey K, Williams J. Efficiency of continuous-wave Doppler in screening high risk pregnancies in a district general hospital (a prospective randomized study on 674 singleton pregnancies); Proceedings of 26th British Congress of Obstetrics and Gynaecology; Manchester, UK. 1992 July 7-10; p. 6. 1992.
    1. Biljan MM, McVey KP, Haddad NG. The value of continuous wave doppler assessment of fetal umbilical artery in management of “at risk” pregnancies; Proceedings of 2nd European Congress on Prostaglandins in Reproduction; The Hague, Netherlands. 1991 April 30-May 3; p. 189. 1991.

References to studies excluded from this review

    1. Davies JA, Gallivan S, Spencer JAD. Randomised controlled trial of doppler ultrasound screening of placental perfusion during pregnancy. Lancet. 1992;340:1299–303. - PubMed
    1. Gonsoulin W. Umbilical artery Doppler waveform analysis: a randomized study on effect on outcome. American Journal of Obstetrics and Gynecology. 1991;164:370.
    1. Mason GC, Lilford RJ, Porter J, Nelson E, Tyrell S. Randomised comparison of routine vs highly selective use of Doppler ultrasound in low risk pregnancies. British Journal of Obstetrics and Gynaecology. 1993;100:130–3. - PubMed
    1. McCowan LME, Harding J, Roberts AB, Barker S, Townend K. Perinatal morbidity in small for gestational age fetuses in relation to umbilical doppler; Proceedings of the 14th Annual Congress of the Australian Perinatal Society in conjunction with the New Zealand Perinatal Society; Adelaide, Australia. 1996 March 24-27; p. P10. 1996.
    1. McParland P, Pearce JM. Doppler blood flow in pregnancy. Placenta. 1988;9:427–50. - PubMed

References to ongoing studies

    1. Cambridge Consortium . Trial of umbilical and fetal flow in Europe (TRUFFLE) (ongoing trial) National Research Register; [accessed 6 July 2006]. www.nrr.nhs.uk
    1. Lees C, Baumgartner H. The TRUFFLE study - a collaborative publicly funded project from concept to reality: how to negotiate an ethical, administrative and funding obstacle course in the European Union. Ultrasound in Obstetrics and Gynecology. 2005;25:105–7. - PubMed

Additional references

    1. Al-Ghazali WH, Chapman MG, Rissik JM, Allan LD. The significance of absent end-diastolic flow in the umbilical artery combined with reduced fetal cardiac output estimation in pregnancies at high risk for placental insufficiency. Journal of Obstetrics and Gynaecology. 1990;10:271–5.
    1. Alfirevic Z, Neilson JP. Doppler ultrasonography in high-risk pregnancies: systematic review with meta-analysis. American Journal of Obstetrics and Gynecology. 1995;172:1379–87. - PubMed
    1. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. European Journal Obstetetrics & Gynecology and Reproductive Biology. 2002;101(1):6–14. - PubMed
    1. Almstrom H, Axelsson O, Ekman G, Ingemarsson I, Maesel A, Arstrom K, et al. Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms. Acta Obstetricia et Gynecologica Scandinavica. 1995;74:526–9. - PubMed
    1. Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens. Ultrsound in Obstetrics & Gynecology. 2001;18:571–7. - PubMed

References to other published versions of this review

    1. Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews. 1995;(1) Art. No.: CD000073. DOI: 10.1002/14651858.CD000073.pub2. - PubMed
    1. Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews. 1996;(4) Art. No.: CD000073. DOI: 10.1002/14651858.CD000073. - PubMed

    1. * Indicates the major publication for the study