Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening

Feucht, Ute Dagmar; Hlongwane, Tsakane; Vannevel, Valerie; Mulol, Helen; Botha, Tanita; Pattinson, Robert Clive

doi:10.9745/ghsp-d-21-00692

Cited by 2 publications

(2 citation statements)

References 34 publications

(59 reference statements)

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“…Studies reporting on results of implementing continuous-wave Doppler ultrasound (CWDU) at various sites throughout South Africa and four other LMICs have shown a significant reduction in stillbirths when the screening was combined with appropriate follow-up of foetuses identified as being at risk [ 11 – 14 ]. In the biggest study (Umbi9), a CWDU device called Umbiflow™ was implemented for screening at nine study sites.…”

Section: Introductionmentioning

confidence: 99%

Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa

Hlongwane

Pattinson

Bergh

2023

BMC Pregnancy Childbirth

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Introduction Detecting the risk of stillbirth during pregnancy remains a challenge. Continuous-wave Doppler ultrasound (CWDU) can be used to screen for placental insufficiency, which is a major cause of stillbirths in low-risk pregnant women. This paper describes the adaptation and implementation of screening with CWDU and shares critical lessons for further rollout. Screening of 7088 low-risk pregnant women with Umbiflow™ (a CWDU device) was conducted in 19 antenatal care clinics at nine study sites in South Africa. Each site comprised a catchment area with a regional referral hospital and primary healthcare antenatal clinics. Women with suspected placental insufficiency as detected by CWDU were referred for follow-up at the hospital. A 35–43% reduction in stillbirths was recorded. Methods The authors followed an iterative reflection process using the field and meeting notes to arrive at an interpretation of the important lessons for future implementation of new devices in resource-constrained settings. Results Key features of the implementation of CWDU screening in pregnancy combined with high-risk follow-up are described according to a six-stage change framework: create awareness; commit to implement; prepare to implement; implement; integrate into routine practice; and sustain practice. Differences and similarities in implementation between the different study sites are explored. Important lessons include stakeholder involvement and communication and identifying what would be needed to integrate screening with CWDU into routine antenatal care. A flexible implementation model with four components is proposed for the further rollout of CWDU screening. Conclusions This study demonstrated that the integration of CWDU screening into routine antenatal care, combined with standard treatment protocols at a higher-level referral hospital, can be achieved with the necessary resources and available maternal and neonatal facilities. Lessons from this study could contribute to future scale-up efforts and help to inform decisions on improving antenatal care and pregnancy outcomes in low- and middle-income countries.

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Section: Introductionmentioning

confidence: 99%

Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa

Hlongwane

Pattinson

Bergh

2023

BMC Pregnancy Childbirth

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“…In addition to closely monitoring dynamic changes in fetal weight and abdominal circumference, clinicians pay special attention to changes in fetal Doppler blood flow signals. This is because an increasing body of research has demonstrated a close relationship between FGR and abnormal fetal blood flow[6][7][8]. By examining fetal vascular blood flow signals, it is possible to assist in distinguishing FGR from normal SGA and effectively monitor the intrauterine status of FGR fetuses, thereby reducing adverse outcomes associated with FGR.…”

mentioning

confidence: 99%

Comparison and Analysis of Cerebroplacental Ratio and Umbilicocerebral Ratio in the Prenatal Diagnosis and Severity Assessment of Fetal Growth Restriction: A Retrospective Study and Systematic Review

Zheng,

Zhao,

Mao

et al. 2024

Arch Obstet Gynecol

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Purpose: Doppler flow parameters of fetal umbilical artery (UA) and middle cerebral artery (MCA) have been widely used for fetal growth restriction (FGR), but their diagnostic efficacy remains contentious. The purpose of this study is to clarify the superiority of cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR) in terms of their correlation and predictive accuracy in diagnosing FGR. Methods: Doppler flow parameters of the UA and MCA were tested for FGR patients and normal pregnant women during the third trimester. Collection of delivery gestational weeks and neonatal birth weight were conducted. Logistic regression and area under the curve (AUC) analysis were used to elucidate the association and diagnostic accuracy of CPR and UCR for diagnosing FGR. Results: The CPR-EDV and CPR-MFV in FGR patients were higher, while the CPR-S/D, CPR-PI, and CPR-RI were lower (P<0.05). The UCR-EDV in the FGR group was lower than that in the NC group, while the UCR-S/D and UCR-PI were higher than those in the NC group (P<0.05). Only the CPR-PI (OR:0.166, 95% CI 0.049 ~ 0.563, P = 0.004) was independently associated with FGR. A positive correlation between CPR-PI and delivery gestational weeks was found, as well as neonatal birth weight. The AUC of CPR-PI for detecting FGR was 0.719 (95% CI 0.594 ~ 0.844; P=0.003), with a critical value of 1.57. Conclusion: Compared with UCR and simple UA or MCA blood flow parameters, CPR-PI may be the most optimized ultrasound parameter for diagnosing and assessing FGR.

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Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening

Cited by 2 publications

References 34 publications

Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa

Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa

Comparison and Analysis of Cerebroplacental Ratio and Umbilicocerebral Ratio in the Prenatal Diagnosis and Severity Assessment of Fetal Growth Restriction: A Retrospective Study and Systematic Review

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