Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial.
ABSTRACT A randomized clinical trial was performed to test the hypothesis that if suspected intrauterine growth retardation (IUGR) is associated with normal umbilical artery Doppler ultrasound findings, hospitalization can safely be avoided. One hundred and fifty women with singleton pregnancies and suspected IUGR were randomized between an intervention (n = 74) and a control group (n = 76). In the intervention group, clinicians were strongly requested not to hospitalize for suspected IUGR if the Doppler findings were normal. In the control group, the Doppler results were not revealed and the participants received the standard management for suspected IUGR. Endpoints of the trial were: costs in terms of hospitalization, perinatal outcome, neurological development, and postnatal growth. Duration of hospitalization was significantly shorter in the intervention group than in the control group. Contrary to expectations, the hospitalization rate during pregnancy in the intervention group was not below that of the control group. This negative finding was partly due to the admission of patients in the intervention group despite their normal Doppler results. Moreover, the trial might have induced a more critical attitude towards hospitalization in suspected IUGR, decreasing admission in the control group. No clear differences were found in perinatal outcome, neurological development, or postnatal growth. The results suggest that normal umbilical artery Doppler findings in suspected cases of IUGR justify outpatient management.
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ABSTRACT: To evaluate the performance of different antenatal tools for the monitoring of fetuses with isolated intrauterine growth restriction (IUGR). To define the prenatal management of IUGR and indications for delivery before and after 32 weeks of gestation. PubMed, Embase and the Cochrane databases were searched using the keywords "IUGR", "fetal growth restriction", "cardiotocography", "amniotic fluid", "ultrasound assessment", "biophysical profile", "Doppler ultrasonography", "randomized trial", "meta-analysis". These terms were also combined together. Fetal monitoring of isolated IUGR should be based on the combined use of fetal heart rate (FHR) and ultrasound Doppler. The use of computerized FHR, with short-term variability (STV) measurement allows longitudinal monitoring and provides objective values upon which to decide very premature delivery (LE3). The use of umbilical Doppler is associated with a decrease in perinatal morbidity, especially in IUGR (LE1). It should be the first-line mean for the monitoring of SGA and IUGR fetuses (LE1). The additional use of cerebral Doppler is associated with a better predictive value for a poor perinatal outcome than the umbilical Doppler alone (LE3). Therefore, cerebral Doppler should be used in fetuses with IUGR, whether the umbilical Doppler is normal or not. As morbidity and mortality is increased in IUGR with pathological ductus venosus, the use of this Doppler should be considered in the monitoring of IUGR at before 32 weeks (professional consensus). Routine hospitalization is not mandatory for the monitoring of fetuses with IUGR/SGA. However, tertiary referral is advisable in cases of severe IUGR at between 26 to 32 weeks (professional consensus). The decision for delivery cannot be standardized and should be based on the combined analysis of gestational age, fetal heart rate analysis and Doppler study (professional consensus). Monitoring of fetuses with IUGR and decision for delivery should be based on the combined analysis of gestational age, fetal heart rate analysis and Doppler study before 32 weeks, this should ideally be performed by the association of computerized FHR and arterial and venous Doppler.Journal de Gynécologie Obstétrique et Biologie de la Reproduction 11/2013; · 0.45 Impact Factor
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ABSTRACT: OBJECTIVE: To compare the brain sparing mechanism of the fetal vertebral artery (VA), with the one of the middle cerebral artery (MCA) in fetuses with increased umbilical artery (UA) Doppler impedance. METHOD: We retrospectively studied 1084 Doppler examinations of the VA, MCA and UA performed in 1084 fetuses between 19 and 41 week of gestation. These were divided into 3 groups according to the UA resistance index (UA RI): group 1: UA RI < 95(th) percentile (N = 965), group 2: UA RI > 95(th) percentile (N = 111) and group 3: absent UA diastolic flow (N = 8). Afterwards, values were converted into multiples of the median (MoM), and means and standard deviations were calculated. Finally, Kruskal-Wallis tests and box and whiskers charts were applied to evaluate differences. RESULTS: For both, the VA RI and MCA RI, no differences were seen among the groups of fetuses who maintained diastolic flow in the UA. However, the VA RI and MCA RI were lower when the UA diastolic flow was absent. CONCLUSION: The VA and MCA work in unison, decreasing impedances only when UA flow is severely affected. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012.Journal of Clinical Ultrasound 12/2012; · 0.70 Impact Factor
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ABSTRACT: To determine whether routine echocardiography increases diagnosis and treatment of patent ductus arteriosus (PDA) and whether randomized non-disclosure is a feasible strategy for studying PDA management. 2 center pilot randomized, controlled trial. 88 infants with birth weights <1250 grams and gestational ages <30 weeks were randomized to disclosure or non-disclosure of serial echocardiogram findings. Echocardiograms were performed at 3-5 and 7-10 days of life. The primary outcome was time to regain birth weight. 100% of echocardiograms in the disclosure group were disclosed; 16% (echocardiogram #1) and 29% (echocardiogram #2) were disclosed in the non-disclosure group. There was a statistically non-significant decrease in drug therapy for PDA in the non-disclosure group (adjusted odds ratio [AOR] 0.56, 95% confidence interval [CI] 0.24-1.34). There was no difference in time to regain birth weight or in other important neonatal outcomes. However, infants in the non-disclosure group were more likely to demonstrate appropriate weight loss and then regain birth weight within 7-14 days (AOR 2.64, 95% CI 1.08-6.44). Randomized non-disclosure of echocardiograms is a feasible strategy for evaluation of approaches to PDA management in very preterm infants. Avoidance of routine echocardiography may reduce drug therapy for PDA without adverse clinical effects. This article is protected by copyright. All rights reserved.Acta Paediatrica 08/2013; · 1.97 Impact Factor