Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials

Abstract

Objective Meta-analysis of data from controlled trials performed in populations at high risk have shown that umbilical artery Doppler velociinetry (umbilical Doppler) can reduce perinatal mortality. The individual published trials among unselected or low risk populations have found no beneficial effect. Our objective was to evaluate the effect of routine use of the umbilical Doppler in unselected or low risk pregnancies by reviewing all published and unpublished randomised controlled trials.Study design Systematically reviewing published and unpublished trials, we selected trials for the overview only if they were completed randomised trials of umbilical Doppler in unselected or low risk pregnancies. Of the seven trials examined, three were not included in the meta-analysis because of methodological problems or because they did not meet the inclusion criteria. We therefore included four trials: two in unselected and two in low risk populations. These four groups were comparable in their degree of maternal and perinatal risk. Using the Mantel-Haenzel statistical method and pooling the data, we considered 1 1,375 women in the meta-analysis. Results Systematic use of the Doppler umbilical artery velocimetry had no statistically significant effect on perinatal deaths in unselected populations (odds ratio [OR] 1-28; 95% confidence interval [CI]0.61-2-67), low risk populations (OR 0.5 1; 95% CI 0.20-1-29) or overall for the four trials (OR 0.90; 95% CI 0.50-1.60); nor was there any significant effect on stillbirths (global OR 0-94; 95% CI 0.42-1.98). However, the number of participants remain insufficient and further information is required to arrive at a definite conclusion on the absence of effect. The meta-analysis showed no significant difference between the Doppler groups and the control groups for antenatal hospitalisation, obstetric outcome or perinatal morbidity.Conclusion Based on the results of the published trials, routine use of the umbilical Doppler cannot be recommended.

A prospective study of role of color Doppler in high-risk pregnancies in a tertiary care hospital

“…[1] It has been studied that Doppler velocimetry of umbilical artery in unselected and low-risk pregnancies cannot be recommended. [2] In contrast, it has been proved by many studies that Doppler has a very important role in screening of high-risk pregnancies. [3][4][5] Abnormal fetal circulation is considered a major factor in fetal growth restriction, both as a cause and an indicator.…”

Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study

“…Few interventions exist to prevent FGR, but the surveillance of growth‐restricted fetuses makes it possible to induce delivery in order to avoid severe fetal compromise or death. Antenatal monitoring includes umbilical artery Doppler velocimetry, allowing for a 30% reduction in perinatal mortality in high‐risk pregnancies …”

Fetal umbilical artery Doppler to predict compromise of fetal/neonatal wellbeing in a high‐risk population: systematic review and bivariate meta‐analysis

“…These findings have been further confirmed by a Cochrane review on fetal and umbilical Doppler scans in high‐risk pregnancies16. In unselected and low‐risk populations the previously published evidence has not supported the routine use of umbilical artery Doppler12, 13. One test accuracy study looked at the use of intrapartum umbilical artery Doppler and concluded that it was a poor predictor of adverse outcome49.…”

“…Previous systematic reviews have reported varying results11–15, the most striking originating from a series of reviews of randomized controlled trials (RCT) in high‐risk populations, in which an association with Doppler ultrasound and a reduction in perinatal deaths (risk ratio = 0.71; 95% CI, 0.52–0.98) was demonstrated16. There was also an association with fewer instances of induction of labor (risk ratio = 0.89; 95% CI, 0.80–0.99) and fewer Cesarean sections (risk ratio = 0.90; 95% CI, 0.84–0.97).…”