Randomised controlled trial of cardiotocography versus umbilical artery Doppler in the management of small for gestational age fetuses

Abstract

Objective: To compare the impact on use of resources in the management of small for gestational age babies using Doppler ultrasound versus cardiotocography.

Design: A randomised controlled trial.

Setting: A large district general hospital delivering 5500 to 6000 infants each year, 30% to 35% of which are to women of Pakistani origin.

Population: One hundred and fifty women delivered of small for gestational age infants.

Main outcome measures: Primary outcome measures were length of hospital inpatient stay and induction of labour rates. Secondary outcome measures included caesarean section rates and length of stay on neonatal unit.

Results: The use of Doppler reduced average hospital inpatient stay from 2.5 days to 1.1 days, compared with cardiotocography (P = 0.036). There was no effect on induction of labour rates or caesarean section rates. There was no significant difference in length of stay on the neonatal unit (P = 0.33). There was a reduction in monitoring frequency and fewer hospital antenatal clinic visits.

Conclusion: The use of Doppler ultrasound to manage small for gestational age infants reduces the use of resources, compared with cardiotocography.