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A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics

Westergaard, H.B.; Langhoff-Roos, J.; Lingman, Göran LU ; Marsal, Karel LU and Kreiner, S. (2001) In Ultrasound in Obstetrics & Gynecology 17(6). p.466-476
Abstract
Objectives To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high-risk pregnancies and determine which high-risk pregnancies benefit from the use of Doppler velocimetry, Methods Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high-risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy ('well-defined studies;); the rest included a great variety of high-risk pregnancies (general risk studies'). The studies were analyzed with particular regard 50 the heterogeneity and to outcome. Audits of the perinatal deaths... (More)
Objectives To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high-risk pregnancies and determine which high-risk pregnancies benefit from the use of Doppler velocimetry, Methods Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high-risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy ('well-defined studies;); the rest included a great variety of high-risk pregnancies (general risk studies'). The studies were analyzed with particular regard 50 the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts. Results The 'well-defined studies ' had a more uniform study design as compared to the 'general risk studies' and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43 - 0. 72), inductions of labor (0. 78; 0.63 -0. 96), elective deliveries (inductions of labor and elective Cesarean sections) (0. 73; 0.61-0.88) and Cesarean sections (0. 78; 0, 65 - 0. 94). By perinatal audit it was found that more perinatal deaths in the 'well-defined studies' were potentially avoidable by use of Doppler velocimetry (P < 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group. Conclusion The randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta-analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Meta-analysis, High-risk pregnancy, Doppler velocimetry, Intrauterine growth restriction, Perinatal mortality, Umbilical artery
in
Ultrasound in Obstetrics & Gynecology
volume
17
issue
6
pages
466 - 476
publisher
John Wiley & Sons
external identifiers
  • wos:000169599200003
  • scopus:0034973016
ISSN
1469-0705
DOI
10.1046/j.1469-0705.2001.00415.x
language
English
LU publication?
yes
id
30364c9a-3720-4f82-88c5-ab998c343c43 (old id 1119092)
date added to LUP
2008-07-18 14:04:05
date last changed
2018-05-29 10:46:09
@article{30364c9a-3720-4f82-88c5-ab998c343c43,
  abstract     = {Objectives To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high-risk pregnancies and determine which high-risk pregnancies benefit from the use of Doppler velocimetry, Methods Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high-risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy ('well-defined studies;); the rest included a great variety of high-risk pregnancies (general risk studies'). The studies were analyzed with particular regard 50 the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts. Results The 'well-defined studies ' had a more uniform study design as compared to the 'general risk studies' and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43 - 0. 72), inductions of labor (0. 78; 0.63 -0. 96), elective deliveries (inductions of labor and elective Cesarean sections) (0. 73; 0.61-0.88) and Cesarean sections (0. 78; 0, 65 - 0. 94). By perinatal audit it was found that more perinatal deaths in the 'well-defined studies' were potentially avoidable by use of Doppler velocimetry (P &lt; 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group. Conclusion The randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta-analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions.},
  author       = {Westergaard, H.B. and Langhoff-Roos, J. and Lingman, Göran and Marsal, Karel and Kreiner, S.},
  issn         = {1469-0705},
  keyword      = {Meta-analysis,High-risk pregnancy,Doppler velocimetry,Intrauterine growth restriction,Perinatal mortality,Umbilical artery},
  language     = {eng},
  number       = {6},
  pages        = {466--476},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics},
  url          = {http://dx.doi.org/10.1046/j.1469-0705.2001.00415.x},
  volume       = {17},
  year         = {2001},
}