No abstract

Collaborators and participating centres of the French Doppler study group are listed on page 517.Objectives To assess whether systematic screening with an uterine artery Doppler in low risk pregnant women followed by the prescription of low dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction and pre-eclampsia.Design A multicentre randomised trial.Population 3317 low risk pregnant women. In the Doppler group, the uterine artery Doppler was performed between 20 and 24 weeks. Women with abnormal results received 100 mg of aspirin daily until the 35th week. Main outcome measures Intrauterine growth restriction was de®ned as birthweight below the tenth and the third centile according to gestational age. Pre-eclampsia was de®ned as hypertension associated with proteinuria . 0.5g/L.Results Intrauterine growth restriction, whether de®ned by the third or tenth centile, did not differ signi®cantly between the two groups (RR 1.22 [0.73 -2.04] and 1.18 [0.93 -1.51] respectively). Screening with uterine artery Doppler did not affect birthweight or any of the criteria of perinatal morbidity. There was no effect on the incidence of pre-eclampsia (RR 1.99 [0.97 -4.09]) or hypertensive disorders. These results were the same for nulliparae and multiparae. Conclusions There is no justi®cation for screening with uterine artery Doppler in a low risk population, even if abnormal results are followed by aspirin treatment and increased prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of pre-eclampsia and intrauterine growth restriction. Only when all of these conditions are ful®lled, aspirin or other treatments may prove its ef®cacy.

Objectives Two large multicenter randomised trials were performed in France to assess whether systematic screening with an artery uteroplacental Doppler (AUD) in low‐risk pregnant women followed by the prescription of low‐dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction (IUGR) and of preeclampsia. Study design and population The first trial ‘Seine Saint‐Denis’ (SSD) trial included 3317 low‐risk pregnant women (multi and primigravidae) in 17 French maternity Hospitals and the second ‘Erasme’ trial included 1869 primigravidae in 12 centres. In the Doppler group, the AUD was performed between 20 and 24 weeks, and women with abnormal results received 100 mg of aspirin daily until the 35th week. Results In the Doppler group, 232 patients (15.7%) had an abnormal result in the SSD trial and 20% in the ERASME trial. The predictive value of the AUD was comparable to that reported in the studies of low‐risk populations, but with a low sensitivity. Finally, IUGR, whether defined by the third or tenth percentile, and preeclampsia did not differ significantly between the treatment groups in both trials. Conclusions There is no proof justifying the recommendation of a systematic AUD in a low‐risk population, even if abnormal results are followed by aspirin treatment and increase in prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of preeclampsia and IUGR. Only when all of these conditions are fulfilled can aspirin prove its efficacy.