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Meta-Analysis
. 2015 Apr 15;2015(4):CD001450.
doi: 10.1002/14651858.CD001450.pub4.

Fetal and umbilical Doppler ultrasound in normal pregnancy

Zarko Alfirevic  1 , Tamara Stampalija, Nancy Medley
Affiliations
Meta-Analysis

Fetal and umbilical Doppler ultrasound in normal pregnancy

Zarko Alfirevic et al. Cochrane Database Syst Rev. .

Abstract

Background: One of the main aims of routine antenatal care is to identify the 'at risk' fetus in order to apply clinical interventions which could result in reduced perinatal morbidity and mortality. Doppler ultrasound study of umbilical artery waveforms helps to identify the compromised fetus in 'high-risk' pregnancies and, therefore, deserves assessment as a screening test in 'low-risk' pregnancies.

Objectives: To assess the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (28 February 2015) and reference lists of retrieved studies.

Selection criteria: Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared with no Doppler ultrasound. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included.

Data collection and analysis: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. In addition to standard meta-analysis, the two primary outcomes and five of the secondary outcomes were assessed using GRADE software and methodology.

Main results: We included five trials that recruited 14,624 women, with data analysed for 14,185 women. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors. Overall and apart from lack of blinding, the risk of bias for the included trials was considered to be low.Overall, routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions. There were no group differences noted for the review's primary outcomes of perinatal death and neonatal morbidity. Results for perinatal death were as follows: (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.35 to 1.83; four studies, 11,183 participants). Only one included trial assessed serious neonatal morbidity and found no evidence of group differences (RR 0.99, 95% CI 0.06 to 15.75; one study, 2016 participants).For the comparison of a single Doppler assessment versus no Doppler, evidence for group differences in perinatal death was detected (RR 0.36, 95% CI 0.13 to 0.99; one study, 3891 participants). However, these results are based on a single trial, and we would recommend caution when interpreting this finding.There was no evidence of group differences for the outcomes of caesarean section, neonatal intensive care admissions or preterm birth less than 37 weeks.When the quality of the evidence for the main comparison of 'All Doppler versus no Doppler' was assessed with GRADE software, the outcomes of perinatal death and serious neonatal morbidity data were graded as of low quality. Evidence for the outcome of stillbirth was graded according to regimen subgroups - with a moderate quality rating for stillbirth (fetal/umbilical vessels only) and a low quality rating for stillbirth (fetal/umbilical vessels + uterine artery vessels). Evidence for admission to neonatal intensive care unit was assessed as of moderate quality, and evidence for the outcomes of caesarean section and preterm birth less than 37 weeks was graded as of high quality.There is no available evidence to assess the effect on substantive long-term outcomes such as childhood neurodevelopment and no data to assess maternal outcomes, particularly maternal satisfaction.

Authors' conclusions: Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby. Future studies should be designed to address small changes in perinatal outcome, and should focus on potentially preventable deaths.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 1 Perinatal death (stillbirth and neonatal death including anomalies).
1.2
1.2. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 2 Serious neonatal morbidity.
1.3
1.3. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 3 Any death after randomisation (non‐prespecified).
1.4
1.4. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 4 Stillbirth.
1.5
1.5. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 5 Neonatal death (up to 28 days).
1.6
1.6. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 6 Potentially preventable perinatal death.
1.7
1.7. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 7 Fetal acidosis.
1.8
1.8. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 8 Apgar score < 7 at 5 minutes.
1.9
1.9. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 9 Caesarean section (elective and emergency).
1.10
1.10. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 10 Elective caesarean section.
1.11
1.11. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 11 Emergency caesarean section.
1.12
1.12. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 12 Spontaneous vaginal birth.
1.13
1.13. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 13 Operative vaginal birth.
1.14
1.14. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 14 Induction of labour.
1.15
1.15. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 15 Neonatal resuscitation.
1.16
1.16. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 16 Infant intubation/ventilation.
1.17
1.17. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 17 Preterm birth (before 37 weeks).
1.18
1.18. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 18 Neonatal admission to SCBU/NICU.
1.19
1.19. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 19 Birthweight.
1.20
1.20. Analysis
Comparison 1 All routine Doppler ultrasound versus no Doppler ultrasound, Outcome 20 Gestational age at birth.
2.1
2.1. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 1 Perinatal death (stillbirth and neonatal death including anomalies).
2.2
2.2. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 2 Stillbirth.
2.3
2.3. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 3 Neonatal death (up to 28 days after birth).
2.4
2.4. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 4 Any death after randomisation (non‐prespecified).
2.5
2.5. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 5 Potentially preventable perinatal death.
2.6
2.6. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 6 Apgar score < 7 at 5 minutes.
2.7
2.7. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 7 Caesarean section (elective and emergency).
2.8
2.8. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 8 Elective caesarean section.
2.9
2.9. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 9 Emergency caesarean section.
2.10
2.10. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 10 Spontaneous vaginal birth.
2.11
2.11. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 11 Operative vaginal birth.
2.12
2.12. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 12 Induction of labour.
2.13
2.13. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 13 Neonatal resuscitation.
2.14
2.14. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 14 Preterm birth (before 37 weeks).
2.15
2.15. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 15 Birthweight.
2.16
2.16. Analysis
Comparison 2 Single Doppler ultrasound assessment versus no Doppler ultrasound, Outcome 16 Gestational age at birth.
3.1
3.1. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 1 Perinatal death (stillbirth and neonatal death including anomalies).
3.2
3.2. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 2 Serious neonatal morbidity.
3.3
3.3. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 3 Any death after randomisation (non‐prespecified).
3.4
3.4. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 4 Stillbirth.
3.5
3.5. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 5 Neonatal death (up to 28 days).
3.6
3.6. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 6 Potentially preventable perinatal death.
3.7
3.7. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 7 Apgar score < 7 at 5 minutes.
3.8
3.8. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 8 Caesarean section (elective and emergency).
3.9
3.9. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 9 Elective caesarean section.
3.10
3.10. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 10 Emergency caesarean section.
3.11
3.11. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 11 Spontaneous vaginal birth.
3.12
3.12. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 12 Induction of labour.
3.13
3.13. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 13 Neonatal resuscitation.
3.14
3.14. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 14 Preterm birth (before 37 weeks).
3.15
3.15. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 15 Neonatal admission to SCBU/NICU.
3.16
3.16. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 16 Birthweight.
3.17
3.17. Analysis
Comparison 3 Multiple Doppler ultrasound assessments versus no Doppler ultrasound, Outcome 17 Gestational age at birth.
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Update of

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References to other published versions of this review

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