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Fetal and umbilical Doppler ultrasound in high-risk pregnancies

  1. Zarko Alfirevic1,*,
  2. Tamara Stampalija2,
  3. Gillian ML Gyte3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 12 NOV 2013

Assessed as up-to-date: 30 SEP 2013

DOI: 10.1002/14651858.CD007529.pub3


How to Cite

Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD007529. DOI: 10.1002/14651858.CD007529.pub3.

Author Information

  1. 1

    The University of Liverpool, Department of Women's and Children's Health, Liverpool, UK

  2. 2

    Insitute for Maternal and Child Health, IRCCS Burlo Garofalo, Unit of Prenatal Diagnosis, Trieste, Italy

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

*Zarko Alfirevic, Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK. zarko@liverpool.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 12 NOV 2013

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Almstrom 1992 {published data only}
  • Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, Ulmsten U, et al. Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses. Lancet 1992;340:936-40.
  • Almstrom H, Axelsson O, Ekman G, Ingemarsson I, Maesel A, Arstrom K, et al. Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms. Acta Obstetricia et Gynecologica Scandinavica 1995;74:526-9.
  • Marsal K, Almstrom H, Axelsson O, Cnattingius S, Ekman G, Maesel A, et al. Umbilical artery velocimetry is more effective than cardiotocography for surveillance of growth retarded fetuses. Journal of Perinatal Medicine 1991;19(Suppl 2):84.
Biljan 1992 {published and unpublished data}
  • Biljan M, Haddad N, McVey K, Williams J. Efficiency of continuous-wave Doppler in screening high risk pregnancies in a district general hospital (a prospective randomized study on 674 singleton pregnancies). Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7-10; Manchester, UK. 1992:6.
  • Biljan MM, McVey KP, Haddad NG. The value of continuous wave doppler assessment of fetal umbilical artery in management of "at risk" pregnancies. Proceedings of 2nd European Congress on Prostaglandins in Reproduction; 1991 April 30-May 3; The Hague, Netherlands. 1991:189.
Burke 1992 {published data only}
  • Burke G, Stuart B, Crowley P, Ni Scanaill S, Drumm J. Does Doppler ultrasound alter the management of high-risk pregnancy?. Care concern and cure in perinatal medicine. 13th European Congress of Perinatal Medicine; 1992 May; Amsterdam, The Netherlands. Parthenon, 1992:597-604.
  • Burke G, Stuart B, Crowley P, Ni Scanaill S, Drumm J. Does Doppler ultrasound alter the management of high-risk pregnancy?. Journal of Perinatal Medicine 1992;20(Suppl 1):266.
de Rochambeau 1992 {published data only}
  • de Rochambeau B, Jabbour N, Mellier G. Umbilical doppler velocimetry in prolonged pregnancies [La velocimetrie Doppler ombilicale dans les grossesses prolongees]. Revue Francaise de Gynecologie et d Obstetrique 1992;87(5):289-94.
Giles 2003 {published data only}
  • Giles W, Bisits A, O'Callaghan S. The doppler assessment in multiple pregnancy study (damp) and metaanalyses of doppler and twins. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S17.
  • Giles W, Bisits A, O'Callaghan S, Gill A. The doppler assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery doppler ultrasound and biometry in twin pregnancy. BJOG: an international journal of obstetrics and gynaecology 2003;110(6):593-7.
Haley 1997 {published data only}
Hofmeyr 1991 {published data only}
  • Hofmeyr GJ, Pattinson R, Buckley D, Jennings J, Redman CWG. Umbilical artery resistance index as a screening test for fetal well-being. II. Randomized feasibility study. Obstetrics & Gynecology 1991;78:359-62.
Johnstone 1993 {published data only}
Neales 1994 {published data only}
  • Neales K. A randomised controlled study to assess the use of Doppler ultrasound in the management of patients with intrauterine growth retardation. Personal communication 1994.
Newnham 1991 {published data only}
Nienhuis 1997 {published data only}
  • Nienhuis SJ. Costs and effects of Doppler ultrasound measurements in suspected intrauterine growth retardation. A randomised clinical trial [thesis]. Maastricht: Universitaire Pers Maastricht, 1995.
  • Nienhuis SJ, Ruissen CJ, Hoogland HJ, Gerver JW, Vles J, de Haan J. Cost-effectiveness of a doppler policy in suspected intrauterine growth retardation - a randomized controlled trial. Proceedings of 13th World Congress of Gynaecology and Obstetrics (FIGO); 1991 Sept 15-20; Singapore. 1991:32.
  • Nienhuis SJ, Vles JS, Gerver WJ, Hoogland HJ. Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial. Ultrasound in Obstetrics & Gynecology 1997;9(1):6-13.
  • Ruissen CJ, Nienhuis SJ, Hoogland HJ, Vles JFH, Gerver WJ, De Haan J. Cost-effectiveness of a Doppler based policy of suspected intrauterine growth retardation - a randomised controlled trial. Journal of Maternal Fetal Investigation 1992;1:126.
Nimrod 1992 {published data only}
  • Nimrod C, Yee J, Hopkins C, Pierce P, Lange I, Fick G, et al. The utility of pulsed Doppler studies in the evaluation of postdate pregnancies. Journal of Maternal Fetal Investigation 1992;1:127.
Norman 1992 {published data only}
  • Norman K, Pattinson RC, Carstens E. Doppler velocimetry in recurrent pregnancy loss: is there a role?. Proceedings of 11th Conference on Priorities in Perinatal Care in South Africa; 1992 March; Caledon, South Africa. 1992:71-4.
Ott 1998 {published data only}
  • Ott WJ, Mora G, Arias F, Sunderji S, Sheldon G. Comparison of the modified biophysical profile to a new biophysical profile incorporating the middle cerebral artery to umbilical artery velocity flow systolic/diastolic ratio. American Journal of Obstetrics and Gynecology 1998;178(6):1346-53.
Pattinson 1994 {published data only}
  • Pattinson R, Norman K, Odendaal HJ. Management of fetuses suspected of IUGR but with EDVs of the umbilical artery: a randomised controlled trial. Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7-10; Manchester, UK. 1992:5.
  • Pattinson RC, Norman K, Odendaal HJ. The role of Doppler velocimetry in the management of high risk pregnancies. British Journal of Obstetrics and Gynaecology 1994;101:114-20.
  • Pattinson RC, Norman K, Odendaal HJ. The role of doppler velocimetry in the management of pregnancies: a randomized controlled trial. Proceedings of 11th Conference on Priorities in Perinatal Care in South Africa; 1992 March; Caledon, South Africa. 1992:59-63.
Trudinger 1987 {published data only}
  • Trudinger BJ, Cook CM, Giles WB, Connelly AJ, Thompson RS. Umbilical artery flow velocity waveforms in high-risk pregnancy: randomised controlled trial. Lancet 1987;1:188-90.
Tyrrell 1990 {published data only}
  • Lilford RJ. Fetal assessment in laboratory vs standard management of high risk pregnancy. Personal communication 1989.
  • Tyrrell SN, Lilford RJ, MacDonald HN, Nelson EJ, Porter J, Gupta JK. Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies. British Journal of Obstetrics and Gynaecology 1990;97:909-16.
Williams 2003 {published data only}
  • Williams K, Farquharson D, Bebbington M, Dansereau J, Galerneau F, Wilson RD, et al. A randomized controlled clinical trial comparing non stress testing versus doppler velocimetry as a screening test in a high risk population [abstract]. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S109.
  • Williams KP, Farquharson DF, Bebbington M, Dansereau J, Galerneau F, Wilson RD, et al. Screening for fetal well-being in a high-risk pregnant population comparing the nonstress test with umbilical artery doppler velocimetry: a randomized controlled clinical trial. American Journal of Obstetrics and Gynecology 2003;188(5):1366-71.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Davies 1992 {published data only}
Gonsoulin 1991 {published data only}
  • Gonsoulin W. Umbilical artery Doppler waveform analysis: a randomized study on effect on outcome. American Journal of Obstetrics and Gynecology 1991;164:370.
Mason 1993 {published data only}
McCowan 1996 {published data only}
  • McCowan LME, Harding J, Roberts AB, Barker S, Townend K. Perinatal morbidity in small for gestational age fetuses in relation to umbilical doppler. Proceedings of the 14th Annual Congress of the Australian Perinatal Society in conjunction with the New Zealand Perinatal Society; 1996 March 24-27; Adelaide, Australia. 1996:P10.
McParland 1988 {published data only}
Newnham 1993 {published data only}
  • Newnham JP, Evans SF, Michael CA, Stanley FJ, Landau LI. Effects of frequent ultrasound during pregnancy: a randomised controlled trial. Lancet 1993;342:887-91.
Omtzigt 1994 {published data only}
  • Omtzigt AWJ. Clinical value of umbilical doppler velocimetry [thesis]. Utrecht: University of Utrecht, 1990.
  • Omtzigt AWJ, Bruinse HW, Reuwer PJHM. A randomized controlled trial on the clinical value of umbilical Doppler velocimetry. I. Obstetrical management. Proceedings of 12th European Congress of Perinatal Medicine; 1990 Sept 11-14; Lyon, France. 1990:210.
  • Omtzigt AWJ, Bruinse HW, Reuwer PJHM. A randomized controlled trial on the clinical value of umbilical Doppler velocimetry: neonatal outcome. Proceedings of 12th European Congress of Perinatal Medicine; 1990 Sept 11-14; Lyon, France. 1990:189.
  • Omtzigt AWJ, Reuwer PJHM, Bruinse HW. A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care. American Journal of Obstetrics and Gynecology 1994;170:625-34.
Pearce 1992 {published data only}
  • Pearce JM. The application of uteroplacental waveforms to complicated pregnancies. Doppler Ultrasound in Perinatal Medicine. Oxford: Oxford University Press, 1992:159-77.
Schneider 1992 {published data only}
  • Schneider KTM, Renz S, Furstenau U, Amberg-Wendland D, Prochaska D, Graeff H. Doppler flow measurements as a screening method during pregnancy: is it worth the effort?. Journal of Maternal Fetal Investigation 1992;1:125.
Whittle 1994 {published data only}
  • Whittle MJ, Hanretty KP, Primrose MH, Neilson JP. Screening for the compromised fetus: a randomized trial of umbilical artery velocimetry in unselected pregnancies. American Journal of Obstetrics and Gynecology 1994;170:555-9.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Lees 2005 {published data only}
  • Cambridge Consortium. Trial of umbilical and fetal flow in Europe (TRUFFLE) (ongoing trial). National Research Register (www.nrr.nhs.uk) (accessed 6 July 2006).
  • Lees C, Baumgartner H. The TRUFFLE study - a collaborative publicly funded project from concept to reality: how to negotiate an ethical, administrative and funding obstacle course in the European Union. Ultrasound in Obstetrics and Gynecology 2005;25:105-7.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Al-Ghazali 1990
  • Al-Ghazali WH, Chapman MG, Rissik JM, Allan LD. The significance of absent end-diastolic flow in the umbilical artery combined with reduced fetal cardiac output estimation in pregnancies at high risk for placental insufficiency. Journal of Obstetrics and Gynaecology 1990;10:271-5.
Alfirevic 1995
Alfirevic 2002
  • Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. European Journal Obstetetrics & Gynecology and Reproductive Biology 2002;101(1):6-14.
Alfirevic 2010b
  • Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in normal pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 8. [DOI: 10.1002/14651858.CD001450.pub3]
Almstrom 1995
Baschat 2001
Baschat 2002
Bernstein 2000
  • Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. American Journal of Obstetrics and Gynecology 2000;182:198-206.
Bilardo 1990
  • Bilardo CM, Nicolaides KH, Campbell S. Doppler measurements of fetal and uteroplacental circulations: relationship with umbilical venous blood gases measured at cordocentesis. American Journal of Obstetrics and Gynecology 1990;162:115-20.
Bilardo 2004
BJOG 1995
Bricker 2007
  • Bricker L, Neilson JP. Routine Doppler ultrasound in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD001450.pub2]
Burns 1993
  • Burns PN. Principles of Doppler and color flow. Radiology in Medicine 1993;85:3-16.
Cheema 2004
Chen 1996
CONSORT 2001
Deeks 2001
  • Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DJ editor(s). Systematic Reviews in Health Care: Meta-Analysis in Context. London: BMJ, 2001.
Devane 2007
Egger 1997
  • Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.
Ferrazzi 2002
  • Ferrazzi E, Bozzo M, Rigano S, Bellotti M, Morabito A, Pardi G, et al. Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus. Ultrasound in Obstetrics & Gynecology 2002;19:140-6.
Figueras 2008
Fisk 2001
  • 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.
Fitzgerald 1977
  • Fitzgerald DE, Drumm JE. Non-invasive measurement of the human circulation using ultrasound: a new method. British Medical Journal 1977;2:1450-1.
Gates 2004
Giles 1985
Graves 2007
  • Graves CR. Antepartum fetal surveillance and timing of delivery in the pregnancy complicated by diabetes mellitus. Clinical Obstetrics and Gynecology 2007;50(4):1007-13.
Greer 1999
GRIT 2003
  • GRIT Study Group. A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. BJOG: an international journal of obstetrics and gynaecology 2002;110:27-32.
GRIT 2004
  • GRIT study group. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet 2004;364:513-20.
Harbord 2006
Hecher 2001
Higgins 2008
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
Higgins 2009
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Lalor 2008
Mari 2009
  • Mari G. Doppler ultrasonography in obstetrics: from the diagnosis of fetal anemia to the treatment of intrauterine growth-restricted fetuses. American Journal of Obstetrics and Gynecology 2009;200(6):613.e1-613.e9.
Mires 2000
  • Mires GJ, Patel NB, Dempster J. Review: The value of fetal umbilical artery flow velocity waveforms in the prediction of adverse fetal outcome in high risk pregnancies. Journal of Obstetrics and Gynaecology 2000;10:261-70.
Neilson 1987
Nicholaides 1988
  • Nicholaides KH, Bilardo CM, Soothill PW, Campbell S. Absence of end diastolic frequencies in umbilical artery: a sign of fetal hypoxia and acidosis. BMJ 1988;297(6655):1026-7.
Nienhuis 1995
  • Nienhuis SJ. Costs and effects of Doppler ultrasound measurements in suspected intrauterine growth retardation. A randomised clinical trial [thesis]. Maastricht: Universitaire Pers Maastricht, 1995.
Ortibus 2009
  • Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. American Journal of Obstetrics and Gynecology 2009;200(5):494.e1-494.e8.
Owen 2001
  • Owen P. Fetal assessment in the third trimester: fetal growth and biophysical methods. In: Chamberlain G, Steer P editor(s). Turnbull's Obstetrics. 3rd Edition. Edinburgh: Churchill Livingstone, 2001.
Pattison 1999
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Stampalija 2010
Thompson 1990
  • Thompson RS, Trudinger BJ. Doppler waveform pulsatility index and resistance, pressure and flow in the umbilical placental circulation: an investigation using a mathematical model. Ultrasound in Medicine and Biology 1990;16:449.
Trudinger 1985a
Trudinger 1985b
Weiner 1990
  • Weiner CP. The relationship between the umbilical artery systolic/diastolic ratio and umbilical blood gas measurements in specimens obtained by cordocentesis. American Journal of Obstetrics and Gynecology 1990;162:1198-202.
Westergaard 2001
  • Westergaard HB, Langhoff-Roos J, Lingman G, Marsal K, Kreiner S. A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics. Ultrasound in Obstetrics & Gynecology 2001;17:466-76.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Alfirevic 2010
  • Alfirevic Z, Stampalija T, Gyte GML. Fetal and umbilical Doppler ultrasound in high-risk pregnancies. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007529.pub2]
Neilson 1995
  • Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews 1995, Issue 1. [DOI: 10.1002/14651858.CD000073]
Neilson 1996
  • Neilson JP, Alfirevic Z. Doppler ultrasound for fetal assessment in high risk pregnancies. Cochrane Database of Systematic Reviews 1996, Issue 4. [DOI: 10.1002/14651858.CD000073.pub2]