Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review

Abstract

ObjectivesThis systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC).DesignWe searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020.SettingObservational or interventional studies from LMICs.ParticipantsSingleton pregnancies of any risk profile.InterventionsUmbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava.Primary and secondary outcome measuresPerinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO).ResultsWe identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations.ConclusionLocal evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative.PROSPERO registration numberCRD42019128546

Middle cerebral arterial flow redistribution is an indicator for intrauterine fetal compromise in late pregnancy in low‐resource settings: A prospective cohort study

“…35 Our study affirms that fetal cerebral blood flow redistribution is an indicator for intrauterine fetal compromise in the third trimester, a finding particularly important in LMICs, where rigorous evidence on the role of Doppler ultrasound in preventing stillbirths is acutely lacking even though LMICs bear the highest burden of disease. 9,36 Stillbirth rates in sub-Saharan African settings remain substantially high and interventions to reduce their occurrence need to be prioritised. 37 In the current study, the adverse perinatal outcome rates were higher in SGA neonates than in non-SGA neonates, in keeping with previous studies from HICs.…”

Standardization and quality control of Doppler and fetal biometric ultrasound measurements in low‐income setting

“…Perinatal and maternal outcomes were assessed at the time of birth and up to 28 days postnatally. Additional information on the EPID study is published elsewhere [12][13][14] . All women recruited to the main prospective cohort provided informed and written consent, with illiterate participants signing using a thumbprint.…”

“…This quality assessment study was designed and reported in accordance with the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) 11 . We report on the ultrasound measurement quality control protocols followed in the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, a prospective cohort study implemented between 2018 and 2020 in a rural obstetric care facility in western Uganda [12][13][14] . The primary aim of the EPID study was to determine the predictive performance of Doppler ultrasound for adverse perinatal outcome in a low-resource setting.…”

Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes

“…Most of the studies have shown moderate prediction accuracy with an improved performance when UtAD is utilized as part of combined models rather than when used alone [20,34,48 ▪▪ ]. A contemporary systematic review from low-income and middle-income countries, found that the UtAD had a poor predictive value for adverse outcomes in most of the manuscripts they included [49 ▪ ].…”