Intervention Review
Fetal and umbilical Doppler ultrasound in normal pregnancy
Editorial Group: Cochrane Pregnancy and Childbirth Group
Published Online: 4 AUG 2010
Assessed as up-to-date: 30 MAY 2010
DOI: 10.1002/14651858.CD001450.pub3
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD001450. DOI: 10.1002/14651858.CD001450.pub3.
Publication History
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 4 AUG 2010
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 (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.
Plain language summary
Doppler ultrasound of fetal blood vessels in normal pregnancies
One of the main aims of routine antenatal care is to identify babies who are not thriving in the womb. It is possible that medical interventions might improve outcomes for these babies, if they can be identified. Doppler ultrasound uses sound waves to detect the movement of blood in vessels. It is used in pregnancy to study blood circulation in the baby, uterus and placenta. Using it in high-risk pregnancies, where there is concern about baby's condition, shows benefits. However, its value as a screening tool in all pregnancies needs to be assessed as there is a possibility of unnecessary interventions and adverse effects. The review of trials of routine Doppler ultrasound of the baby’s vessels in pregnancy identified five studies involving more than 14,000 women and babies. The studies were not of high quality and were all undertaken in the 1990s. There were no improvements identified for either the baby or the mother, though more data would be needed to prove whether it is effective or not for improving outcomes.