Regimens of fetal surveillance for impaired fetal growth

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 methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 February 2012).

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

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

Main results: We included one trial of 167 women and their babies. 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 (risk ratio (RR) 0.96; 95% confidence interval (CI) 0.35 to 2.63). 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 (mean difference (MD) -4.00; 95% CI -7.79 to -0.21). Women in the twice-weekly surveillance group were 25% more likely to have induction of labour than those in the fortnightly surveillance group (RR 1.25; 95% CI 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.

1

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

1.1. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 1 Perinatal mortality.

1.6. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 6 Admission to neonatal special care or intensive care unit.

1.7. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 7 Gestational age at birth.

1.8. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 8 Low birthweight for gestation at birth.

1.9. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 9 Birthweight.

1.12. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 12 Cord blood acidosis.

1.15. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 15 Use of ventilatory support.

1.22. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 22 Emergency caesarean section for fetal distress.

1.24. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 24 Induction of labour.

1.25. Analysis

Comparison 1 Twice‐weekly versus fortnightly surveillance, Outcome 25 Caesarean section.