Doppler ultrasound for fetal assessment in high risk pregnancies

Neilson, James P; Alfirević, Z̄arko

doi:10.1002/14651858.cd000073

Cited by 74 publications

(30 citation statements)

References 19 publications

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“…A Cochrane review included 11 RCTs comparing umbilical artery Doppler ultrasound in complicated pregnancies with no Doppler, and found a nonsignificant 21% reduction in the stillbirth rate (OR 0.79, 95% CI 0.461.34) [80]. A similar review of late ultrasound examination for all pregnancies - whether or not these were complicated - showed no effect [81].…”

Section: Resultsmentioning

confidence: 99%

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

Barros

Bhutta

Batra

et al. 2010

BMC Pregnancy Childbirth

214

174

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IntroductionInterventions directed toward mothers before and during pregnancy and childbirth may help reduce preterm births and stillbirths. Survival of preterm newborns may also be improved with interventions given during these times or soon after birth. This comprehensive review assesses existing interventions for low- and middle-income countries (LMICs).MethodsApproximately 2,000 intervention studies were systematically evaluated through December 31, 2008. They addressed preterm birth or low birth weight; stillbirth or perinatal mortality; and management of preterm newborns. Out of 82 identified interventions, 49 were relevant to LMICs and had reasonable amounts of evidence, and therefore selected for in-depth reviews. Each was classified and assessed by the quality of available evidence and its potential to treat or prevent preterm birth and stillbirth. Impacts on other maternal, fetal, newborn or child health outcomes were also considered. Assessments were based on an adaptation of the Grades of Recommendation Assessment, Development and Evaluation criteria.ResultsMost interventions require additional research to improve the quality of evidence. Others had little evidence of benefit and should be discontinued. The following are supported by moderate- to high-quality evidence and strongly recommended for LMICs:• Two interventions prevent preterm births—smoking cessation and progesterone• Eight interventions prevent stillbirths—balanced protein energy supplementation, screening and treatment of syphilis, intermittant presumptive treatment for malaria during pregnancy, insecticide-treated mosquito nets, birth preparedness, emergency obstetric care, cesarean section for breech presentation, and elective induction for post-term delivery• Eleven interventions improve survival of preterm newborns—prophylactic steroids in preterm labor, antibiotics for PROM, vitamin K supplementation at delivery, case management of neonatal sepsis and pneumonia, delayed cord clamping, room air (vs. 100% oxygen) for resuscitation, hospital-based kangaroo mother care, early breastfeeding, thermal care, and surfactant therapy and application of continued distending pressure to the lungs for respiratory distress syndromeConclusionThe research paradigm for discovery science and intervention development must be balanced to address prevention as well as improve morbidity and mortality in all settings. This review also reveals significant gaps in current knowledge of interventions spanning the continuum of maternal and fetal outcomes, and the critical need to generate further high-quality evidence for promising interventions.

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Section: Resultsmentioning

confidence: 99%

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

Barros

Bhutta

Batra

et al. 2010

BMC Pregnancy Childbirth

214

174

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show abstract

“…Uterine, umbilical, and fetal Doppler velocimetry are being combined with customized or established growth curves to help providers better estimate fetal survival and optimal timing of delivery. 12,13 Although there is no set algorithm for determining the optimal timing of delivery of the SGA infant, this study adds granularity to the existing data on the risks faced by expectant management.…”

Section: Commentmentioning

confidence: 99%

“…9–12 Moreover, the routine use of Doppler in high-risk pregnancies decreases induction of labor and antepartum admission, suggesting that in the absence of abnormal Doppler findings SGA pregnancies may benefit from expectant management rather than early delivery. 13 …”

mentioning

confidence: 99%

The risk of intrauterine fetal death in the small-for-gestational-age fetus

Pilliod¹,

Cheng²,

Snowden³

et al. 2012

American Journal of Obstetrics and Gynecology

176

139

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OBJECTIVE We sought to evaluate the risk of intrauterine fetal death (IUFD) in small-for-gestational-age (SGA) fetuses. STUDY DESIGN We analyzed a retrospective cohort of all births in the United States in 2005, as recorded in a national database. We calculated the risk of IUFD within 3 sets of SGA threshold categories as well as within non-SGA pregnancies using the number of at-risk fetuses as the denominator. RESULTS The risk of IUFD increased with gestational age and was inversely proportional to percentile of birthweight for gestational age. The risk for IUFD in those <3rd percentile was as high as 58.0 IUFDs per 10,000 at-risk fetuses, 43.9 for <5th percentile, and 26.3 for <10th percentile compared to 5.1 for non-SGA gestations. CONCLUSION There is an increase in the risk of IUFD in SGA fetuses compared to non-SGA fetuses at all gestational ages with the greatest risk demonstrated in the lowest percentile cohort evaluated.

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“…The application of umbilical artery Doppler velocimetry in high risk pregnancy with hypertension or presumed impaired fetal growth has been associated with a trend of reduction in perinatal deaths and also associated with fewer inductions of labor and admissions to hospital 3. It is also available for evaluating the fetal-placental circulation in pregnancies which are suspected to have severe placental insufficiency 4.…”

Section: Introductionmentioning

confidence: 99%

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

et al. 2009

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PurposeTo evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants.Materials and MethodsA total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed.ResultsThe gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007).ConclusionAntenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

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Doppler ultrasound for fetal assessment in high risk pregnancies

Cited by 74 publications

References 19 publications

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

The risk of intrauterine fetal death in the small-for-gestational-age fetus

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

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