Maternal and Infant Health Care Strategies Unit, SAMRC, Pretoria, South Africa
Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
BMJ Open. 2022 Mar 16;12(3):e053622. doi: 10.1136/bmjopen-2021-053622.
Few interventions exist to address the high burden of stillbirths in apparently healthy pregnant women in low- and middle-income countries (LMICs). To establish whether a trial on the impact of routine Doppler screening in a low-risk obstetric population is warranted, we determined the prevalence of abnormal fetal umbilical artery resistance indices among low-risk pregnant women using a low-cost Doppler device in five LMICs.
We conducted a multicentre, prospective cohort study in Ghana, India, Kenya, Rwanda and South Africa. Trained nurses or midwives performed a single, continuous-wave Doppler screening using the Umbiflow device for low-risk pregnant women (according to local guidelines) between 28 and 34 weeks' gestation. We assessed the prevalence of abnormal (raised) resistance index (RI), including absent end diastolic flow (AEDF), and compared pregnancy and health service utilisation outcomes between women with abnormal RI versus those with normal RI.
Of 7151 women screened, 495 (6.9%) had an abnormal RI, including 14 (0.2%) with AEDF. Caesarean section (40.8% vs 28.1%), labour induction (20.5% vs 9.0%) and low birth weight (<2500 g) (15.0% vs 6.8%) were significantly more frequent among women with abnormal RI compared with women with normal RI. Abnormal RI was associated with lower birth weights across all weight centiles. Stillbirth and perinatal mortality rates were similar between women with normal and abnormal RI.
A single Doppler screening of low-risk pregnant women in LMICs using the Umbiflow device can detect a large number of fetuses at risk of growth restriction and consequent adverse perinatal outcomes. Many perinatal deaths could potentially be averted with appropriate intervention strategies.
CTRI/2018/07/01486.
在中低收入国家（LMICs），针对看似健康的孕妇中高比例的死产问题，目前干预措施较少。为了确定在低危产科人群中常规多普勒筛查的影响是否需要进行试验，我们使用低成本多普勒设备在五个 LMICs 中确定低危孕妇中异常胎儿脐动脉阻力指数的流行率。
我们在加纳、印度、肯尼亚、卢旺达和南非进行了一项多中心前瞻性队列研究。受过培训的护士或助产士在 28 至 34 周妊娠期间，使用 Umbiflow 设备为低危孕妇（根据当地指南）进行单次连续波多普勒筛查。我们评估了异常（升高）阻力指数（RI）的流行率，包括无舒张末期血流（AEDF），并比较了 RI 异常和 RI 正常的孕妇的妊娠和卫生服务利用结局。
在 7151 名接受筛查的妇女中，有 495 名（6.9%）的 RI 异常，其中 14 名（0.2%）有 AEDF。RI 异常的孕妇剖宫产率（40.8% vs 28.1%）、引产率（20.5% vs 9.0%）和低出生体重（<2500 g）（15.0% vs 6.8%）明显高于 RI 正常的孕妇。在所有体重百分位中，异常 RI 与较低的出生体重相关。RI 正常和异常的孕妇的死产率和围产儿死亡率相似。
在 LMICs 中，使用 Umbiflow 设备对低危孕妇进行单次多普勒筛查，可以发现许多有生长受限和不良围产结局风险的胎儿。许多围产儿死亡可以通过适当的干预策略来避免。
CTRI/2018/07/01486。
