hoogland HJ. Doppler ultrasonography in suspected intrauterine growth retardation: a randomized clinical trial

Department of Obstetrics and Gynecology, University Hospital Maastricht, The Netherlands.
Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.85). 02/1997; 9(1):6-13. DOI: 10.1046/j.1469-0705.1997.09010006.x
Source: PubMed


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. ln 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 patient 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. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology

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    • "Previous studies showed that, in pregnancies accompanied by FGR, the umbilical artery Doppler velocimetry can discriminate those at high risk for adverse perinatal outcome and predict neonatal outcome.7,18-21 It has also been emphasized that FGR with normal umbilical artery Doppler velocimetry is a disease entity different from those with abnormal umbilical artery Doppler blood flow,22 which may be managed by outpatient care,23 and that SGA fetuses with normal umbilical artery S/D ratios do not show increased morbidity compared to AGA pregnancies.24 In addition, it has been reported that, if the umbilical artery S/D ratio and amniotic fluid volume are normal, adverse outcomes will occur only during delivery of the baby, and therefore, close antenatal surveillance may be unnecessary.25 "
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    ABSTRACT: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants. A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed. The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007). Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.
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    ABSTRACT: The objective of this study was to determine whether the addition of the middle cerebral to umbilical artery systolic/diastolic velocity waveform ratio to the modified biophysical profile would improve perinatal outcome in patients at high risk. A prospective, randomized outcome study of patients referred to the perinatal laboratory for antenatal surveillance was undertaken. Six hundred sixty-five patients were randomized to two antenatal surveillance protocols: group 1, modified biophysical profile; and group 2, modified biophysical profile plus evaluation of the middle cerebral artery to umbilical artery systolic/diastolic ratio. Patients were followed up serially and neonatal outcome data including gestational age at delivery, birth weight, incidence of cesarean section delivery for fetal distress, admission to the neonatal intensive care unit, days in the neonatal intensive care unit, and the presence of significant neonatal morbidity were tabulated. The total population showed no statistical difference in outcome parameters between groups 1 and 2. However, a subgroup of patients evaluated for suspected uteroplacental insufficiency did show a significant reduction in caesarean section for fetal distress in group 2 patients. In a subgroup of patients at risk for uteroplacental insufficiency, the addition of the middle cerebral/umbilical artery ratio to an antenatal surveillance protocol should be expected to improve perinatal outcome.
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    ABSTRACT: Doppler ultrasound used for the assessment of the fetal umbilical circulation in the human pregnancy has been reported in the scientific literature since the early 1980s and has been rigorously evaluated by randomized, controlled trials. The consensus of the reviewers of these trials is that there do appear to be grounds for including umbilical artery Doppler ultrasound studies in the management of high-risk pregnancies. There is no apparent benefit for low-risk pregnancies or later gestation. Other fetal vascular beds are currently undergoing prospective studies and some limited randomized, controlled trials have been reported; but to date they are not at a point of development to be considered part of clinical management.
    No preview · Article · Jan 2000 · Obstetrics and Gynecology Clinics of North America
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