Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

doi:10.1136/bmjopen-2021-049799

. 2021 Dec 2;11(12):e049799.

doi: 10.1136/bmjopen-2021-049799.

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

Sam Ali^{1

2}, Simelina Heuving², Michael G Kawooya³, Josaphat Byamugisha⁴, Diederick E Grobbee², Aris T Papageorghiou⁵, Kerstin Klipstein-Grobusch^{2

6}, Marcus J Rijken^{2

7}

Affiliations

¹ Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda alisambecker@gmail.com.
² Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda.
⁴ Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
⁵ Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁶ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa.
⁷ Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 34857564
PMCID: PMC8640672
DOI: 10.1136/bmjopen-2021-049799

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

Sam Ali et al. BMJ Open. 2021.

. 2021 Dec 2;11(12):e049799.

doi: 10.1136/bmjopen-2021-049799.

Authors

Sam Ali^{1

2}, Simelina Heuving², Michael G Kawooya³, Josaphat Byamugisha⁴, Diederick E Grobbee², Aris T Papageorghiou⁵, Kerstin Klipstein-Grobusch^{2

6}, Marcus J Rijken^{2

7}

Affiliations

¹ Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda alisambecker@gmail.com.
² Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
³ Ernest Cook Ultrasound Research and Education Institute (ECUREI), Kampala, Uganda.
⁴ Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
⁵ Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK.
⁶ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa.
⁷ Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.

PMID: 34857564
PMCID: PMC8640672
DOI: 10.1136/bmjopen-2021-049799

Abstract

Objectives: This systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC).

Design: We searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020.

Setting: Observational or interventional studies from LMICs.

Participants: Singleton pregnancies of any risk profile.

Interventions: Umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava.

Primary and secondary outcome measures: Perinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO).

Results: We identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations.

Conclusion: Local evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative.

Prospero registration number: CRD42019128546.

Keywords: fetal medicine; prenatal diagnosis; ultrasonography; ultrasound.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

**Figure 2**
Risk of bias assessment results of the 30 included studies.

See this image and copyright information in PMC

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References

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1. Lees CC, Stampalija T, Baschat A, et al. . ISUOG practice guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020;56:298–312. 10.1002/uog.22134 - DOI - PubMed
1. Figueras F, Caradeux J, Crispi F, et al. . Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018;218:S790–802. 10.1016/j.ajog.2017.12.003 - DOI - PubMed

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[1] de Bernis L, Kinney MV, Stones W, et al. . Stillbirths: ending preventable deaths by 2030. Lancet 2016;387:703–16. 10.1016/S0140-6736(15)00954-X - DOI - PubMed

[2] de Bernis L, Kinney MV, Stones W, et al. . Stillbirths: ending preventable deaths by 2030. Lancet 2016;387:703–16. 10.1016/S0140-6736(15)00954-X - DOI - PubMed

[3] Lawn JE, Blencowe H, Waiswa P, et al. . Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016;387:587–603. 10.1016/S0140-6736(15)00837-5 - DOI - PubMed

[4] Lawn JE, Blencowe H, Waiswa P, et al. . Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016;387:587–603. 10.1016/S0140-6736(15)00837-5 - DOI - PubMed

[5] Reinebrant HE, Leisher SH, Coory M, et al. . Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2018;125:212–24. 10.1111/1471-0528.14971 - DOI - PubMed

[6] Reinebrant HE, Leisher SH, Coory M, et al. . Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG 2018;125:212–24. 10.1111/1471-0528.14971 - DOI - PubMed

[7] Lees CC, Stampalija T, Baschat A, et al. . ISUOG practice guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020;56:298–312. 10.1002/uog.22134 - DOI - PubMed

[8] Lees CC, Stampalija T, Baschat A, et al. . ISUOG practice guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020;56:298–312. 10.1002/uog.22134 - DOI - PubMed

[9] Figueras F, Caradeux J, Crispi F, et al. . Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018;218:S790–802. 10.1016/j.ajog.2017.12.003 - DOI - PubMed

[10] Figueras F, Caradeux J, Crispi F, et al. . Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol 2018;218:S790–802. 10.1016/j.ajog.2017.12.003 - DOI - PubMed

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Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

Affiliations

Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

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