The effect of introduction of umbilical Doppler recordings to obstetric practice

Abstract

Objective To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results. Design Randomised controlled trial. Setting A large teaching hospital. Subjects Two thousand two hundred and eighty‐nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring. Interventions Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians. Main outcome measures Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of tests of fetal well being: cardiotocography, biophysical profile and ultrasound biometry. Results The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P= 0.007) but no difference in the low risk group. Conclusion Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero‐placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.

Umbilical Artery Doppler in the Assessment of Fetal Growth Restriction

“…31,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] One of the studies is no longer included in any considerations because of the concerns related to scientific integrity. The remaining 20 studies involving a total population of approximately 25,000 women have been reviewed in detail elsewhere 53 and summarized in Table 3.…”

Doppler ultrasound in twin pregnancy

“…30,31 These two trials gave a combined odds ratio of 0.14 (95% con®dence intervals 0.03 to 0.77) for a reduction in intrauterine death. However the total group of twin pregnancies studied were 48 control pregnancies and 34 pregnancies in which Doppler was used in the management.…”

Discordance in fetal biometry and Doppler are independent predictors of the risk of perinatal loss in twin pregnancies

“…Although the use of Doppler assessment in singleton pregnancies with suspected FGR was associated with a reduction in the perinatal mortality (risk ratio, 0.71; 95% CI, 0.52e0.98), it was not possible to draw firm conclusions regarding its value in twin pregnancies. [38][39][40] Most current national guidelines recommend monitoring of twin pregnancies, typically with regular ultrasound assessment of the fetal growth, at frequent intervals. However, the majority fail to specify the frequency of such assessments or which findings are of relevance.…”