Bricker L, Neilson J P
University Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Crown Street, Liverpool, UK, L8 7SS.
Cochrane Database Syst Rev. 2000(2):CD001450. doi: 10.1002/14651858.CD001450.
Doppler ultrasound study of umbilical artery waveforms helps identify the compromised fetus in 'high risk' pregnancies and, therefore, deserves assessment as a screening test in 'low risk' pregnancies. One of the main aims of routine antenatal care is to identify the 'at risk' fetus in order to apply clinical interventions which could result in reduced perinatal morbidity and mortality.
To assess the effects on obstetric practice and pregnancy outcome of routine Doppler ultrasound in unselected and low risk pregnancies.
The Cochrane Pregnancy and Childbirth Group Specialised Register of Controlled Trials and the Cochrane Controlled Trials Register were searched. Date of last search: September 1999
Acceptably controlled trials of routine Doppler ultrasound (umbilical circulation and/or uterine circulation) in unselected or low risk pregnancies.
Both reviewers assessed trial quality and extracted data. Authors of two trials were contacted for additional information.
Five trials were included which recruited 14,338 women. The methodological quality of the trials was generally good. Based on existing evidence, routine Doppler ultrasound examination in low risk or unselected populations did not result in increased antenatal, obstetric and neonatal interventions, and no overall differences were detected for substantive short term clinical outcomes such as perinatal mortality. There is no available evidence to assess the effect on substantive long term outcomes such as childhood neurodevelopment. There is no available evidence to assess maternal outcomes, particularly psychological effects. In two studies there were unexpected findings suggesting possible harmful effects, but the explanation for this is not clear, and further evaluation regarding the safety of Doppler ultrasound is required.
REVIEWER'S CONCLUSIONS: Based on existing evidence, routine Doppler ultrasound in low risk or unselected populations does not confer benefit on mother or baby. Future research should be powerful enough to address small changes in perinatal outcome, and should include evaluation of maternal psychological effects, long term outcomes such as neurodevelopment, and issues of safety.
脐动脉波形的多普勒超声研究有助于识别“高危”妊娠中受损的胎儿，因此，作为“低危”妊娠的一项筛查试验值得评估。常规产前护理的主要目标之一是识别“高危”胎儿，以便采取可降低围产期发病率和死亡率的临床干预措施。
评估常规多普勒超声对未选择的低危妊娠的产科实践及妊娠结局的影响。
检索了Cochrane妊娠与分娩组专业对照试验注册库和Cochrane对照试验注册库。末次检索日期：1999年9月
在未选择的或低危妊娠中进行的关于常规多普勒超声（脐循环和/或子宫循环）的可接受的对照试验。
两位综述作者评估了试验质量并提取了数据。联系了两项试验的作者以获取更多信息。
纳入了五项试验，共招募了14338名女性。试验的方法学质量总体良好。基于现有证据，在低危或未选择人群中进行常规多普勒超声检查并未导致产前、产科及新生儿干预增加，对于围产期死亡率等实质性短期临床结局未发现总体差异。尚无可用证据评估对儿童神经发育等实质性长期结局的影响。尚无可用证据评估对母亲结局的影响，尤其是心理影响。在两项研究中有意外发现提示可能存在有害影响，但对此的解释尚不清楚，需要对多普勒超声的安全性进行进一步评估。
基于现有证据，在低危或未选择人群中进行常规多普勒超声检查对母亲或婴儿均无益处。未来的研究应有足够的效力以解决围产期结局的微小变化，且应包括对母亲心理影响、神经发育等长期结局以及安全性问题的评估。
