Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis

Alfirević, Z; Neilson, James P

doi:10.1016/0002-9378(95)90466-2

Cited by 376 publications

(209 citation statements)

References 15 publications

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“…[8][9][10] Stillbirth is associated with a high resistance pattern of uterine artery and umbilical artery blood flow, which may indicate maldevelopment of the villous tree. [32][33][34] The association between previous caesarean and stillbirth might be, therefore, another manifestation of abnormal placentation caused by a uterine scar. Consistent with this interpretation, stillbirths in women with a previous caesarean section were more likely to be small for gestational age than stillbirths in other women.…”

Section: Discussionmentioning

confidence: 99%

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

2003

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Glasgow ePrints Servicehttp://eprints.gla.ac.uk SummaryBackground Caesarean section is associated with an increased risk of disorders of placentation in subsequent pregnancies, but effects on the rate of antepartum stillbirth are unknown. We aimed to establish whether previous caesarean delivery is associated with an increased risk of antepartum stillbirth.Methods We linked pregnancy discharge data from the Scottish Morbidity Record (1980-98) and the Scottish Stillbirth and Infant Death Enquiry . We estimated the relative risk of antepartum stillbirth in second pregnancies using timeto-event analyses.Findings For 120 633 singleton second births, there were 68 antepartum stillbirths in 17 754 women previously delivered by caesarean section (2·39 per 10 000 women per week) and 244 in 102 879 women previously delivered vaginally (1·44; p<0·001). Risk of unexplained stillbirth associated with previous caesarean delivery differed significantly with gestational age (p=0·04); the excess risk was apparent from 34 weeks (hazard ratio 2·23 [95% CI 1·48-3·36]). Risk was not attenuated by adjustment for maternal characteristics or outcome of the first pregnancy (2·74 [1·74-4·30]). The absolute risk of unexplained stillbirth at or after 39 weeks' gestation was 1·1 per 1000 women who had had a previous caesarean section and 0·5 per 1000 in those who had not. The difference was due mostly to an excess of unexplained stillbirths among women previously delivered by caesarean section.Interpretation Delivery by caesarean section in the first pregnancy could increase the risk of unexplained stillbirth in the second. In women with one previous caesarean delivery, the risk of unexplained antepartum stillbirth at or after 39 weeks' gestation is about double the risk of stillbirth or neonatal death from intrapartum uterine rupture.

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Section: Discussionmentioning

confidence: 99%

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

2003

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“…Placental insufficiency often complicates pre-eclampsia and may cause fetal distress, hypoxaemia, metabolic acidosis, perinatal demise, morbidity and long-term impairment. 2,5,6 The coexistence, temporal changes and prognostic implications of abnormal ultrasound and Doppler findings are now well described in placental insufficiency, [7][8][9] but while knowledge of umbilical artery Doppler results 10 is of clear clinical benefit, the use of other ultrasound and Doppler parameters has not yet been shown to improve perinatal outcome. In preterm pre-eclampsia, some studies have investigated the prognostic value of such parameters close to delivery, [11][12][13][14][15][16][17] but combinations of parameters, their inter-relations and the influence of confounding variables in this setting have not been investigated widely.…”

Section: Introductionmentioning

confidence: 99%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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“…14 Berkowitz GS et al and various studies have reported on the association of abnormal umbilical artery velocity waveforms with fetal growth restriction and its prediction Alfirevic et al published a systematic review with the meta-analysis addressing the usefulness of Doppler in the surveillance of high-risk pregnancies. 15,16 Two groups of high-risk pregnant patients were identified and allocated to either a standard fetal assessment protocol or to standard fetal assessment plus Doppler ultrasound testing. Their results showed a decrease in perinatal mortality in the second group.…”

Section: Discussionmentioning

confidence: 99%

Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

Bhattacharjee

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy. The aim of this study was to study the umbilical artery Doppler velocimetry in predicting the fetal outcome in high risk pregnancy. This is a prospective study done over a period of 1 year in Silchar Medical College and Hospital from 1st September 2011 to 31st August 2012. 100 women with singleton pregnancy with high risk admitted in SMCH were subjected to umbilical artery Doppler along with morphology and biometry scan after fulfilling the inclusion and exclusion criteria.Methods: 100 women with high risk pregnancy were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal Doppler group (n = 79; 79%), the low-end diastolic flow group (n = 19; 19%) and the group with absent/reversed diastolic flow (n = 2; 2%).Results: Mothers with abnormal velocimetry had more number of caesarean sections than those with normal velocimetry. The diagnosis to delivery interval, gestational age at delivery and average birth weight were comparatively lower with higher incidence of admission to neonatal intensive care unit in foetuses with abnormal umbilical Doppler velocimetry. Sensitivity, specificity, positive and negative predictive values of Doppler for detecting abnormal fetal outcome were 43%, 83%, 33% and 88% respectively. Statistical analysis used: sensitivity, specificity and predictive values.Conclusions: Fetuses with normal flow velocimetry are at lower risk than those with abnormal velocimetry in terms of poor Apgar score and neonatal intensive care admission. The average birth weight of the neonates with abnormal Doppler studies was lower than that of neonates with normal velocimetry. Doppler velocimetry studies of umbilical artery can provide the obstetrician important information regarding fetal wellbeing to help him improve fetal outcome.

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Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis

Cited by 376 publications

References 15 publications

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Umbilical artery Doppler indices in relation to fetal outcome in high risk pregnancy

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