Objective-To test whethcr the introduction of Doppler wavcform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management. Design-A randomized controlled trial. Setting-Department of Ultrasound, King Edward Memorial Hospital, Perth, Westcrn Australia. Subjecrs-505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester. Zntervention-Continuous wave Doppler studies of umbilical and uteroplaccntal arterial circulations. Results were rcvealed to patients and clinicians. Main outcome measures-Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric intervcntions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care.Results-Thcre was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewcr contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distrcss after induction of labour leading to emergency cacsarean section. Depressed Apgar scores were more frequent in the study group. Conclusion-Introduction of Doppler waveform studies did not result in rcduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice.In recent years examination of umbilical and uteroplacental arterial waveforms by Doppler
Data from 3,953 consecutive second trimester genetic amniocenteses were analysed to determine pregnancy loss rates up to 6 weeks after the procedure. Information was prospectively collected on a cohort of 3,685 women in 3,896 singleton and 50 twin pregnancies, from 2 operating sites in Perth, Western Australia, using 9 operators over the 6-year period, 1989 to 1995. Complete information regarding pregnancy outcome was obtained for 3,643 of the 3,685 women (98.9%). There were 27 identified singletons and 1 set of twins lost within 6 weeks following amniocentesis. The overall pregnancy loss rate in this cohort was 29 of 3,911 (0.74%). The pregnancy loss rate associated with genetic amniocentesis is not excessive in comparison to the calculated background pregnancy loss rate of 1%, and it is suggested that each prenatal diagnostic team should determine their own complication rates for the purpose of counselling prior to amniocentesis.
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