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Cited by 198Pregnancy and preeclampsia studiesMaternal and Perinatal Health InterventionsPrenatal Screening and Diagnostics

Fetal and umbilical Doppler ultrasound in normal pregnancy

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Alfirevic, Zarko, Stampalija, Tamara, Medley, Nancy·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd001450.pub4PMC PMC6464774
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Abstract

BACKGROUND: One of the main aims of routine antenatal care is to identify the 'at risk' fetus in order to apply clinical interventions which could result in reduced perinatal morbidity and mortality. Doppler ultrasound study of umbilical artery waveforms helps to identify the compromised fetus in 'high-risk' pregnancies and, therefore, deserves assessment as a screening test in 'low-risk' pregnancies. OBJECTIVES: To assess the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (28 February 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared with no Doppler ultrasound. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. In addition to standard meta-analysis, the two primary outcomes and five of the secondary outcomes were assessed using GRADE software and methodology. MAIN RESULTS: We included five trials that recruited 14,624 women, with data analysed for 14,185 women. All trials had adequate allocation concealment, but none had adequate blinding of participants, staff or outcome assessors. Overall and apart from lack of blinding, the risk of bias for the included trials was considered to be low.Overall, routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions. There were no group differences noted for the review's primary outcomes of perinatal death and neonatal morbidity. Results for perinatal death were as follows: (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.35 to 1.83; four studies, 11,183 participants). Only one included trial assessed serious neonatal morbidity and found no evidence of group differences (RR 0.99, 95% CI 0.06 to 15.75; one study, 2016 participants).For the comparison of a single Doppler assessment versus no Doppler, evidence for group differences in perinatal death was detected (RR 0.36, 95% CI 0.13 to 0.99; one study, 3891 participants). However, these results are based on a single trial, and we would recommend caution when interpreting this finding.There was no evidence of group differences for the outcomes of caesarean section, neonatal intensive care admissions or preterm birth less than 37 weeks.When the quality of the evidence for the main comparison of 'All Doppler versus no Doppler' was assessed with GRADE software, the outcomes of perinatal death and serious neonatal morbidity data were graded as of low quality. Evidence for the outcome of stillbirth was graded according to regimen subgroups - with a moderate quality rating for stillbirth (fetal/umbilical vessels only) and a low quality rating for stillbirth (fetal/umbilical vessels + uterine artery vessels). Evidence for admission to neonatal intensive care unit was assessed as of moderate quality, and evidence for the outcomes of caesarean section and preterm birth less than 37 weeks was graded as of high quality.There is no available evidence to assess the effect on substantive long-term outcomes such as childhood neurodevelopment and no data to assess maternal outcomes, particularly maternal satisfaction. AUTHORS' CONCLUSIONS: Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby. Future studies should be designed to address small changes in perinatal outcome, and should focus on potentially preventable deaths.

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  1. Fisk NM, Smith RP. Fetal growth restriction; small for gestational age. In: Chamberlain G, Steer P editor(s). Turnbull's Obstetrics. 3rd Edition. Edinburgh: Churchill Livingstone, 2001:197-209.

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Authors
Alfirevic, Z., Stampalija, T., & Medley, N.
Affiliations
  • The University of Liverpool; Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
  • IRCCS Materno Infantile Burlo Garofolo (IT)
  • University of Liverpool (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-04-15
Volume
2015
Issue
6
Pages
CD001450-CD001450
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd001450.pub4
PMC
PMC6464774
OpenAlex
W1550707014
Cited by
198
References
67
Citations by year
2026: 6 · 2025: 11 · 2024: 11 · 2023: 18 · 2022: 12 · 2021: 22 · 2020: 15 · 2019: 14 · 2018: 21 · 2017: 18 · 2016: 15 · 2015: 10 · 2014: 9 · 2013: 6 · 2012: 6
FWCI
3.13
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • World Health Organization
  • UNICEF
  • McMaster University
  • National Institute for Health and Care Research
  • Evidence Synthesis Programme
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
Keywords
fetal Doppler, umbilical artery Doppler, low-risk pregnancy, prenatal screening, perinatal death, neonatal morbidity, obstetric surgery, fetal growth restriction, fetal heart rate monitoring, fetal biometry, uterine artery Doppler, fetal monitoring
MeSH terms
Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Umbilical Arteries, Randomized Controlled Trials as Topic, Ultrasonography, Prenatal, Ultrasonography, Doppler, Perinatal Mortality, Uterine Artery

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