School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK.
Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):141-55. doi: 10.1016/j.ejogrb.2012.07.027. Epub 2012 Aug 15.
Identification of the fetus at risk of compromise is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving perinatal outcome. The accuracy of middle cerebral artery (MCA) Doppler for prediction of the fetus at risk of compromise of wellbeing is not known. The objective of this systematic review with bivariate meta-analysis was to evaluate the accuracy of middle cerebral artery Doppler for prediction of compromise of fetal/neonatal wellbeing.
Systematic review and bivariate meta-analysis with searches of Medline, Embase, Cochrane library, Medion (inception to October 2011), hand searching of journal and reference lists, contact with experts. Two reviewers independently selected articles in which the results of middle cerebral artery Doppler were associated with the occurrence of compromise of fetal/neonatal wellbeing. There were no language restrictions applied.
Thirty-five studies, testing 4025 fetuses, met the selection criteria. Data were extracted on study characteristics, quality and results to construct 2×2 tables. Likelihood ratios for positive and negative test results, sensitivity, specificity and their 95% confidence intervals were generated for the different indices and thresholds. Meta-analysis showed low predictive accuracy. For prediction of adverse perinatal outcome and perinatal mortality the results were positive likelihood ratios 2.77 (1.93, 3.96) and 1.36 (1.10, 1.67) and negative likelihood ratios 0.58 (0.48, 0.69) and 0.51 (0.29, 0.89) respectively.
Abnormal middle cerebral artery Doppler showed limited predictive accuracy for compromise of fetal/neonatal wellbeing. High quality primary research or individual patient data meta-analysis looking at this test in combination with other tests is required.
识别有风险的胎儿对于明智地分配监测资源和使用预防性治疗以改善围产期结局至关重要。大脑中动脉（MCA）多普勒超声预测胎儿健康状况风险的准确性尚不清楚。本系统评价的目的是使用双变量 meta 分析评估大脑中动脉多普勒超声预测胎儿/新生儿健康状况风险的准确性。
系统评价和双变量 meta 分析，检索 Medline、Embase、Cochrane 图书馆、Medion（从创建到 2011 年 10 月）、杂志和参考文献的手工搜索、与专家联系。两名审查员独立选择了将大脑中动脉多普勒超声结果与胎儿/新生儿健康状况风险发生相关的文章。未应用语言限制。
35 项研究，共检测了 4025 例胎儿，符合选择标准。提取研究特征、质量和结果以构建 2×2 表。为不同的指标和阈值生成阳性和阴性试验结果的似然比、敏感性、特异性及其 95%置信区间。荟萃分析显示预测准确性较低。对于预测不良围产结局和围产儿死亡率，结果为阳性似然比 2.77（1.93，3.96）和 1.36（1.10，1.67），阴性似然比 0.58（0.48，0.69）和 0.51（0.29，0.89）。
异常大脑中动脉多普勒超声对胎儿/新生儿健康状况风险的预测准确性有限。需要高质量的原始研究或个体患者数据荟萃分析，该测试与其他测试相结合。
