Alfirevic Zarko, Stampalija Tamara, Gyte Gillian Ml
School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, UK, L8 7SS.
Cochrane Database Syst Rev. 2010 Aug 4(8):CD001450. doi: 10.1002/14651858.CD001450.pub3.
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. Doppler ultrasound study of umbilical artery waveforms helps to identify the compromised fetus in 'high-risk' pregnancies and, therefore, deserves assessment as a screening test in 'low-risk' pregnancies.
To assess the effects on obstetric practice and pregnancy outcome of routine fetal and umbilical Doppler ultrasound in unselected and low-risk pregnancies.
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (May 2010).
Randomised and quasi-randomised controlled trials of Doppler ultrasound for the investigation of umbilical and fetal vessels waveforms in unselected pregnancies compared to no Doppler ultrasound. Studies where uterine vessels have been assessed together with fetal and umbilical vessels have been included.
Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
We included five trials involving 14,185 women. The methodological quality of the trials was generally unclear because of insufficient data included in the reports.Routine fetal and umbilical 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 and no data to assess maternal outcomes, particularly psychological effects.
AUTHORS' CONCLUSIONS: Existing evidence does not provide conclusive evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations benefits either mother or baby. Future studies should be designed to address small changes in perinatal outcome, and should focus on potentially preventable deaths.
常规产前护理的主要目标之一是识别“高危”胎儿，以便采取临床干预措施，从而降低围产期发病率和死亡率。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”妊娠的筛查试验值得评估。
评估常规胎儿及脐部多普勒超声对未选择的低危妊娠产科实践及妊娠结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2010年5月）。
与未进行多普勒超声检查相比，对未选择的妊娠进行多普勒超声检查以研究脐部和胎儿血管波形的随机和半随机对照试验。包括同时评估子宫血管以及胎儿和脐部血管的研究。
两位作者独立评估纳入研究，评估偏倚风险并进行数据提取。
我们纳入了5项试验，涉及14185名女性。由于报告中包含的数据不足，试验的方法学质量总体不明确。低危或未选择人群的常规胎儿及脐部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检测到总体差异。没有可用证据评估对儿童神经发育等实质性长期结局的影响，也没有数据评估母亲结局，尤其是心理影响。
现有证据未提供确凿证据表明在低危或未选择人群中使用常规脐动脉多普勒超声或脐动脉与子宫动脉多普勒超声联合使用对母亲或婴儿有益。未来研究应旨在解决围产期结局的微小变化，并应关注潜在可预防的死亡。
