Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

Abstract

CONTRIBUTION What are the novel findings of this work?This study provides evidence of a higher risk of adverse outcome in suspected third-trimester small-forgestational-age (SGA) fetuses with abnormal uterine artery Doppler, which is comparable to that in late SGA fetuses with abnormal cerebroplacental ratio. What are the clinical implications of this work?The findings from this study should enable clinicians to assess the risk of adverse perinatal outcome in SGA fetuses, using the likelihood ratios of abnormal third-trimester uterine artery Doppler to calculate the posterior probability, using an evidence-based approach. ABSTRACTObjective To investigate the predictive ability for adverse perinatal outcome of abnormal third-trimester uterine artery Doppler in late small-for-gestational-age (SGA) fetuses.Methods A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third-trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95 th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver-operating-characteristics (ROC) curves were con-structed using random-effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment.Results Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized-controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third-trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5-min Apgar score < 7, neonatal acidosis and perinatal death were: 52.3% vs 20.2%, 48.6% vs 18.7%, 23.1% vs 15.2%, 3.59% vs 1.32%, 9.15% vs 5.12% and 31.4% vs 1.64%, respectively.Conclusion Abnormal uterine artery Doppler in the third trimester appears to be moderately useful in predicting perinatal death in pregnancies with suspected SGA.

Associations of maternal age at the start of pregnancy with placental function throughout pregnancy: The Generation R Study

“…A systematic review has shown that model performance for screening for gestational hypertensive disorders varies with the use of different maternal, fetal and placental characteristics among low-risk and high-risk populations [40]. A meta-analysis comprising seventeen observational studies showed that among SGA fetuses and newborns, which is considered a high-risk population, concluded that an increased UtA-PI increased the risk of adverse perinatal outcomes, but because of limited predictive capacity as a standalone test, UtA-PI should be combined in combination with other tests [41]. Although causality cannot be established in observational research, these findings suggest that maternal age may, through suboptimal utero-placental vascular function, influence pregnancy outcomes.…”

FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction

“…183 There are many conceptual explanations to support thirdtrimester ultrasound as it can assist in the diagnosis of clinically significant findings other than FGR, including fetal malpresentation, 184 disorders of amniotic fluid, and fetal anomalies, 185,186 especially when combined with Doppler measurements and biochemical markers. 95,[187][188][189] However, there is no evidence that this information improves outcomes when performed routinely in lowrisk pregnancies.…”

Effect of Maternal and Fetal Characteristics in Feto-Placental Doppler and Impact of Using Adjusted Standards in the Definition of Fetal Growth Restriction at Term

“…However, in the group of FGR by both standards, the induction rate was even higher (56%) but the perinatal outcomes significantly poorer. Second, we do not have information on the uterine Doppler, which is also a Doppler parameter that has been proposed to define FGR as a reflection of the placental functioning from the maternal side [28]. Likewise, we do not have information on the placental findings to compare our study groups.…”