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Meta-Analysis
. 2010 Sep 8;2010(9):CD008363.
doi: 10.1002/14651858.CD008363.pub2.

Utero-placental Doppler ultrasound for improving pregnancy outcome

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

Utero-placental Doppler ultrasound for improving pregnancy outcome

Tamara Stampalija et al. Cochrane Database Syst Rev. .

Abstract

Background: Impaired placentation can cause some of the most important obstetrical complications such as pre-eclampsia and intrauterine growth restriction and has been linked to increased fetal morbidity and mortality. The failure to undergo physiological trophoblastic vascular changes is reflected by the high impedance to the blood flow at the level of the uterine arteries. Doppler ultrasound study of utero-placental blood vessels, using waveform indices or notching, may help to identify the 'at-risk' women in the first and second trimester of pregnancy, such that interventions might be used to reduce maternal and fetal morbidity and/or mortality.

Objectives: To assess the effects on pregnancy outcome, and obstetric practice, of routine utero-placental Doppler ultrasound in first and second trimester of pregnancy in pregnant women at high and low risk of hypertensive complications.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2010) and the reference lists of identified studies.

Selection criteria: Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of utero-placental vessel waveforms in first and second trimester compared with no Doppler ultrasound. We have excluded studies where uterine vessels have been assessed together with fetal and umbilical vessels.

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

Main results: We found two studies involving 4993 participants. The methodological quality of the trials was good. Both studies included women at low risk for hypertensive disorders, with Doppler ultrasound of the uterine arteries performed in the second trimester of pregnancy. In both studies, pathological finding of uterine arteries was followed by low-dose aspirin administration.We identified no difference in short-term maternal and fetal clinical outcomes.We identified no randomised studies assessing the utero-placental vessels in the first trimester or in women at high risk for hypertensive disorders.

Authors' conclusions: Present evidence failed to show any benefit to either the baby or the mother when utero-placental Doppler ultrasound was used in the second trimester of pregnancy in women at low risk for hypertensive disorders. Nevertheless, this evidence cannot be considered conclusive with only two studies included. There were no randomised studies in the first trimester, or in women at high risk. More research is needed to investigate whether the use of utero-placental Doppler ultrasound may improve pregnancy outcome.

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Conflict of interest statement

No known conflicts of interest.

Figures

Figure 1
Figure 1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Analysis 2.1
Analysis 2.1
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 1 Any perinatal death after randomisation.
Analysis 2.2
Analysis 2.2
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 2 Hypertensive disorders.
Analysis 2.3
Analysis 2.3
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 3 Stillbirth.
Analysis 2.4
Analysis 2.4
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 4 Neonatal death.
Analysis 2.5
Analysis 2.5
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 5 Any potentially preventable perinatal death after randomisation.
Analysis 2.7
Analysis 2.7
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 7 Intrauterine growth restriction.
Analysis 2.9
Analysis 2.9
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 9 Neonatal resuscitation.
Analysis 2.12
Analysis 2.12
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 12 Apgar score < 7 at 5 min.
Analysis 2.13
Analysis 2.13
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 13 Neonatal admission to SCBU or NICU.
Analysis 2.15
Analysis 2.15
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 15 Iatrogenic preterm birth (< 37 weeks).
Analysis 2.16
Analysis 2.16
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 16 Caesarean section (both elective and emergency).
Analysis 2.17
Analysis 2.17
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 17 Elective caesarean section.
Analysis 2.18
Analysis 2.18
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 18 Emergency caesarean section.
Analysis 2.21
Analysis 2.21
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 21 Gestational age at birth.
Analysis 2.22
Analysis 2.22
Comparison 2 Uterine artery Doppler ultrasound versus no Doppler ultrasound, 2nd trimester, Outcome 22 Infant birthweight.
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Update of

  • doi: 10.1002/14651858.CD008363

References

References to studies included in this review

    1. Goffinet F, Aboulker D, Paris‐Llado J, Bucourt M, Uzan M, Papiernik E, et al. Screening with a uterine doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomised controlled trial. British Journal of Obstetrics and Gynaecology 2001;108:510‐8. - PubMed
    1. Subtil D, Goeusse P, Houfflin‐Debarge V, Puech F, Lequien P, Breart G, et al. Randomised comparison of uterine artery doppler and aspirin (100 mg) with placebo in nulliparous women: the Essai Regional Aspirine Mere‐Enfant study (part 2). BJOG: an International Journal of Obstetrics & Gynaecology 2003;110(5):485‐91. - PubMed
    2. Subtil D, Truffert P, Goeusse P, Dufour P, Uzan S, Breart G, et al. Value of systematic doppler +/‐ low dose aspirin to prevent vascular complications in primigravidae. Hypertension in Pregnancy 2000;19(Suppl 1):9.

References to studies excluded from this review

    1. 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
    2. 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
    3. 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. Ben‐Ami M, Battino S, Geslevich Y, Shalev E. A random single Doppler study of the umbilical artery in the evaluation of pregnancies complicated by diabetes. American Journal of Perinatology 1995;12(6):437‐8. - PubMed
    1. 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; 1992 July 7‐10; Manchester, UK. 1992:6.
    2. 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; 1991 April 30‐May 3; The Hague, Netherlands. 1991:189.
    1. Burke G, Stuart B, Crowley P, Ni Scanaill S, Drumm J. Does Doppler ultrasound alter the management of high‐risk pregnancy?. Care concern and cure in perinatal medicine. 13th European Congress of Perinatal Medicine; 1992 May; Amsterdam, The Netherlands. Parthenon, 1992:597‐604.
    2. Burke G, Stuart B, Crowley P, Ni Scanaill S, Drumm J. Does Doppler ultrasound alter the management of high‐risk pregnancy?. Journal of Perinatal Medicine 1992;20(Suppl 1):266.
    1. Breart G, Uzan S, Uzan M. Doppler ultrasound screening during pregnancy [Letter; comment]. Lancet 1993;341(8843):501‐2. - PubMed
    2. Davies J, Spencer J, Gallivan S. Randomised trial of Doppler screening in a general obstetric population. Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7‐10; Manchester, UK. 1992:316.
    3. Davies JA, Gallivan S, Spencer JAD. Randomised controlled trial of doppler ultrasound screening of placental perfusion during pregnancy. Lancet 1992;340:1299‐303. - PubMed
    4. Spencer JAD, Davies JA, Gallivan S. Randomised trial of routine Doppler screening during pregnancy. Journal of Maternal Fetal Investigation 1992;1:126.

References to studies awaiting assessment

    1. Ellwood D. Predicting adverse pregnancy outcomes with ultrasound. Personal communication1997.
    1. Snaith V. Support and reassurance in antenatal care (ongoing trial). Current Controlled Trials (http://controlled‐trials.com/mrct) (accessed 21 March 2006).

Additional references

    1. Aardema MW, Oosterhof H, Timmer A, Rooy I, Aarnoudse JG. Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre‐eclampsia and small for gestational age fetuses. Placenta 2001;22(5):405‐11. - PubMed
    1. Albaiges G, Missfelder‐Lobos H, Lees C, Parra M, Nicolaides KH. One‐stage screening for pregnancy complications by color Doppler assessment of the uterine arteries at 23 weeks' gestation. Obstetrics & Gynecology 2000;96(4):559‐64. - PubMed
    1. Alfirevic Z, Stampalija T, Gyte GML, Neilson JP. Fetal and umbilical Doppler ultrasound in high risk pregnancies. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007529.pub2] - DOI - PMC - PubMed
    1. Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 8. [DOI: 10.1002/14651858.CD001450.pub3] - DOI - PMC - PubMed
    1. Askie LM, Duley L, Henderson‐Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre‐eclampsia: a meta‐analysis of individual patient data. Lancet 2007;369:1791‐8. - PubMed

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