Fetal and umbilical Doppler ultrasound in normal pregnancy.
Summary of "Fetal and umbilical Doppler ultrasound in normal pregnancy."
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
STRATEGY:
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2010). SELECTION
CRITERIA:
Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared to no Doppler ultrasound. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included. DATA COLLECTION AND
ANALYSIS:
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. MAIN
RESULTS:
We included five trials involving 14,185 women. The methodological quality of the trials was generally unclear because of insufficient data included in the reports.Routine fetal and umbilical Doppler ultrasound examination in low-risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions, and no overall differences were detected for substantive short term clinical outcomes such as perinatal mortality. 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 psychological effects. 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.
Affiliation
School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
Journal Details
This article was published in the following journal.
Name: Cochrane database of systematic reviews (Online)
ISSN: 1469-493X
Pages: CD001450
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20687066
- DOI: http://dx.doi.org/10.1002/14651858.CD001450.pub3
Medical and Biotech [MESH] Definitions
Nuchal Cord
A complication of pregnancy in which the UMBILICAL CORD wraps around the fetal neck once or multiple times. In some cases, cord entanglement around fetal neck may not affect pregnancy outcome significantly. In others, the nuchal cord may lead to restricted fetal blood flow, oxygen transport, fetal development, fetal movement, and complicated delivery at birth.
Vasa Previa
Pregnancy complication where fetal blood vessels, normally inside the umbilical cord, are left unprotected and cross FETAL MEMBRANES. It is associated with antepartum bleeding and FETAL DEATH and STILLBIRTH due to exsanguination.
Ultrasonography, Doppler
Ultrasonography applying the Doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. (Stedman, 25th ed)
Cordocentesis
The collecting of fetal blood samples via ultrasound-guided needle aspiration of the blood in the umbilical vein.
Ultrasonography, Doppler, Duplex
Ultrasonography applying the Doppler effect combined with real-time imaging. The real-time image is created by rapid movement of the ultrasound beam. A powerful advantage of this technique is the ability to estimate the velocity of flow from the Doppler shift frequency.
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