Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Alfirević, Z̄arko; Stampalija, Tamara; Dowswell, Therese

doi:10.1002/14651858.cd007529.pub4

Cited by 152 publications

(161 citation statements)

References 71 publications

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“…This same pattern was observed in the present study, where SGA pregnancies had an increased risk of stillbirth from 33 weeks onwards. Pilliod et al [3] demonstrated a dose-response effect, where SGA babies below the 3rd centile were at greater risk of stillbirth across all gestations compared with AGA LGA v. AGA*, RR of stillbirth (95% CI) 28 -…”

Section: Discussionmentioning

confidence: 99%

“…[27] This method can increase the ability to detect fetuses with pathological growth restriction and reduce perinatal mortality in high-risk women. [28] Doppler velocimetry conducted at earlier gestations has poor predictive value in detecting late-onset placental insufficiency. [29] In SA, significant challenges persist with Doppler measurement, as a large number of perinatal deaths occur in healthy mothers who are clinically considered low risk [13] and are therefore not referred for Doppler screening.…”

Section: Researchmentioning

confidence: 97%

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Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

et al. 2019

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Background. There is little published work on the risk of stillbirth across pregnancy for small-for-gestational-age (SGA) and large-forgestational (LGA) pregnancies in low-resource settings. Objectives. To compare stillbirth risk across pregnancy between SGA and appropriate-for-gestational-age (AGA) pregnancies in Western Cape Province, South Africa (SA). Methods. A retrospective audit of perinatal mortality data using data from the SA Perinatal Problem Identification Program was conducted. All audited stillbirths with information on size for gestational age (N=677) in the Western Cape between October 2013 and August 2015 were included in the study. The Western Cape has antenatal care (ANC) appointments at booking and at 20, 26, 32, 34, 36, 38 and 41 (if required) weeks' gestation. A fetuses-at-risk approach was adopted to examine stillbirth risk (28 -42 weeks' gestation, ≥1 000 g) across gestation by size for gestational age (SGA <10th centile Theron growth curves, LGA >90th centile). Stillbirth risk was compared between SGA/LGA and AGA pregnancies. Results. SGA pregnancies were at an increased risk of stillbirth compared with AGA pregnancies between 30 and 40 weeks' gestation, with the relative risk (RR) ranging from 3.5 (95% confidence interval (CI) 1.6 -7.6) at 30 weeks' gestation to 15.3 (95% CI 8.8 -26.4) at 33 weeks' gestation (p<0.001). The risk for LGA babies increased by at least 3.5-fold in the later stages of pregnancy (from 37 weeks) (p<0.001). At 38 weeks, the greatest increased risk was seen for LGA pregnancies (RR 6.6, 95% CI 3.1 -14.2; p<0.001). Conclusions. There is an increased risk of stillbirth for SGA pregnancies, specifically between 33 and 40 weeks' gestation, despite fortnightly ANC visits during this time.LGA pregnancies are at an increased risk of stillbirth after 37 weeks' gestation. This high-risk period highlights potential issues with the detection of fetuses at risk of stillbirth even when ANC is frequent.

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Section: Discussionmentioning

confidence: 99%

Section: Researchmentioning

confidence: 97%

Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

et al. 2019

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“…induction of labor). Indeed, antenatal detection of high‐risk fetuses is associated with a significant reduction in stillbirth and perinatal morbidity rates.…”

Section: Introductionmentioning

confidence: 99%

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Kabiri

Romero²,

Gudicha

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To compare the predictive performance of estimated fetal weight (EFW) percentiles, according to eight growth standards, to detect fetuses at risk for adverse perinatal outcome. Methods This was a retrospective cohort study of 3437 African‐American women. Population‐based (Hadlock, INTERGROWTH‐21st, World Health Organization (WHO), Fetal Medicine Foundation (FMF)), ethnicity‐specific (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)), customized (Gestation‐Related Optimal Weight (GROW)) and African‐American customized (Perinatology Research Branch (PRB)/NICHD) growth standards were used to calculate EFW percentiles from the last available scan prior to delivery. Prediction performance indices and relative risk (RR) were calculated for EFW < 10th and > 90th percentiles, according to each standard, for individual and composite adverse perinatal outcomes. Sensitivity at a fixed (10%) false‐positive rate (FPR) and partial (FPR < 10%) and full areas under the receiver‐operating‐characteristics curves (AUC) were compared between the standards. Results Ten percent (341/3437) of neonates were classified as small‐for‐gestational age (SGA) at birth, and of these 16.4% (56/341) had at least one adverse perinatal outcome. SGA neonates had a 1.5‐fold increased risk of any adverse perinatal outcome (P < 0.05). The screen‐positive rate of EFW < 10th percentile varied from 6.8% (NICHD) to 24.4% (FMF). EFW < 10th percentile, according to all standards, was associated with an increased risk for each of the adverse perinatal outcomes considered (P < 0.05 for all). The highest RRs associated with EFW < 10th percentile for each adverse outcome were 5.1 (95% CI, 2.1–12.3) for perinatal mortality (WHO); 5.0 (95% CI, 3.2–7.8) for perinatal hypoglycemia (NICHD); 3.4 (95% CI, 2.4–4.7) for mechanical ventilation (NICHD); 2.9 (95% CI, 1.8–4.6) for 5‐min Apgar score < 7 (GROW); 2.7 (95% CI, 2.0–3.6) for neonatal intensive care unit (NICU) admission (NICHD); and 2.5 (95% CI, 1.9–3.1) for composite adverse perinatal outcome (NICHD). Although the RR CIs overlapped among all standards for each individual outcome, the RR of composite adverse perinatal outcome in pregnancies with EFW < 10th percentile was higher according to the NICHD (2.46; 95% CI, 1.9–3.1) than the FMF (1.47; 95% CI, 1.2–1.8) standard. The sensitivity for composite adverse perinatal outcome varied substantially between standards, ranging from 15% for NICHD to 32% for FMF, due mostly to differences in FPR; this variation subsided when the FPR was set to the same value (10%). Analysis of AUC revealed significantly better performance for the prediction of perinatal mortality by the PRB/NICHD standard (AUC = 0.70) compared with the Hadlock (AUC = 0.66) and FMF (AUC = 0.64) standards. Evaluation of partial AUC (FPR < 10%) demonstrated that the INTERGROWTH‐21st standard performed better than the Hadlock standard for the prediction of NICU admission and mechanical ventilation (P < 0.05 for both). Although fetuses with EFW > 90t...

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“…In fetal growth restriction (FGR), Doppler ultrasound examination can be used to distinguish between fetuses that are at risk of adverse perinatal outcome and those that are constitutionally small. Current FGR guidelines recommend umbilical artery (UA) Doppler as an important surveillance tool, since its clinical effectiveness in high‐risk pregnancies has been reported in a Cochrane review of 18 randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis

Heidweiller-Schreurs

Boer

Heymans

et al. 2018

Ultrasound in Obstet & Gyne

181

127

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ObjectiveDoppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) is widely used as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. However, reported estimates of its accuracy vary considerably. The aim of this study was to review systematically the prognostic accuracies of CPR and MCA Doppler in predicting adverse perinatal outcome, and to compare these with UA Doppler, in order to identify whether CPR and MCA Doppler evaluation are of added value to UA Doppler.MethodsPubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, from inception to June 2016, for studies on the prognostic accuracy of UA Doppler compared with CPR and/or MCA Doppler in the prediction of adverse perinatal outcome in women with a singleton pregnancy of any risk profile. Risk of bias and concerns about applicability were assessed using the QUADAS‐2 (Quality Assessment of Diagnostic Accuracy Studies‐2) tool. Meta‐analysis was performed for multiple adverse perinatal outcomes. Using hierarchal summary receiver–operating characteristics meta‐regression models, the prognostic accuracy of CPR vs MCA Doppler was compared indirectly, and CPR and MCA Doppler vs UA Doppler compared directly.ResultsThe search identified 4693 articles, of which 128 studies (involving 47 748 women) were included. Risk of bias or suboptimal reporting was detected in 120/128 studies (94%) and substantial heterogeneity was found, which limited subgroup analyses for fetal growth and gestational age. A large variation was observed in reported sensitivities and specificities, and in thresholds used. CPR outperformed UA Doppler in the prediction of composite adverse outcome (as defined in the included studies) (P < 0.001) and emergency delivery for fetal distress (P = 0.003), but was comparable to UA Doppler for the other outcomes. MCA Doppler performed significantly worse than did UA Doppler in the prediction of low Apgar score (P = 0.017) and emergency delivery for fetal distress (P = 0.034). CPR outperformed MCA Doppler in the prediction of composite adverse outcome (P < 0.001) and emergency delivery for fetal distress (P = 0.013).ConclusionCalculating the CPR with MCA Doppler can add value to UA Doppler assessment in the prediction of adverse perinatal outcome in women with a singleton pregnancy. However, it is unclear to which subgroup of pregnant women this applies. The effectiveness of the CPR in guiding clinical management needs to be evaluated in clinical trials. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

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Fetal and umbilical Doppler ultrasound in high-risk pregnancies

Abstract: Background-Abnormal blood flow patterns in fetal circulation detected by Doppler ultrasound may indicate poor fetal prognosis. It is also possible false positive Doppler ultrasound findings could encourage inappropriate early delivery.

Cited by 152 publications

References 71 publications

Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

Prediction of adverse perinatal outcome by fetal biometry: comparison of customized and population‐based standards

Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta‐analysis

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