Alfirevic Z, Neilson J P
Department of Obstetrics and Gynaecology, University of Liverpool, United Kingdom.
Am J Obstet Gynecol. 1995 May;172(5):1379-87. doi: 10.1016/0002-9378(95)90466-2.
Our objective was to review all available (published and unpublished) randomized controlled trials of Doppler ultrasonography of the umbilical artery in high-risk pregnancies.
Only completed randomized controlled trials were included and reviewed according to the prespecified protocol. Data were sought for 24 prespecified perinatal outcomes. All meta-analyses were based on the "intention to treat." Primary outcome was defined as perinatal death (any death in utero or postnatally recorded during duration of individual randomized controlled trial). Reported perinatal outcomes that were not prespecified were meta-analyzed on a post hoc basis.
Twenty randomized controlled trials of Doppler ultrasonography were identified; 12 fulfilled the prespecified criteria. Meta-analysis shows a significant reduction in the number of antenatal admissions (44%, 95% confidence interval 28% to 57%), inductions of labor (20%, 95% confidence interval 10% to 28%), and cesarean sections for fetal distress (52%, 95% confidence interval 24% to 69%) in the Doppler group and that the clinical action guided by Doppler ultrasonography reduces the odds of perinatal death by 38% (95% confidence interval 15% to 55%). The reduction in perinatal deaths was also observed in five mortality subgroups (i.e., stillbirths, neonatal deaths, deaths of normally formed babies, normally formed stillbirths, and deaths of normally formed neonates). Post hoc analyses revealed a statistically significant reduction in elective delivery, intrapartum fetal distress, and hypoxic encephalopathy in the Doppler group.
There is now compelling evidence that women with high-risk pregnancies, including preeclampsia and suspected intrauterine growth retardation, should have access to Doppler ultrasonographic study of umbilical artery waveforms.
我们的目的是回顾所有关于高危妊娠脐动脉多普勒超声检查的现有（已发表和未发表）随机对照试验。
仅纳入根据预先指定方案完成的随机对照试验并进行回顾。针对24项预先指定的围产期结局收集数据。所有荟萃分析均基于“意向性治疗”。主要结局定义为围产期死亡（在个体随机对照试验期间记录的任何宫内或产后死亡）。未预先指定的报告围产期结局在事后进行荟萃分析。
确定了20项关于多普勒超声检查的随机对照试验；其中12项符合预先指定的标准。荟萃分析显示，多普勒组的产前入院次数显著减少（44%，95%置信区间28%至57%）、引产次数减少（20%，95%置信区间10%至28%）以及因胎儿窘迫行剖宫产的次数减少（52%，95%置信区间24%至69%），并且由多普勒超声检查指导的临床行动使围产期死亡几率降低了38%（95%置信区间15%至55%）。在五个死亡亚组（即死产、新生儿死亡、正常形态婴儿死亡、正常形态死产和正常形态新生儿死亡）中也观察到围产期死亡的减少。事后分析显示，多普勒组的择期分娩、产时胎儿窘迫和缺氧性脑病在统计学上有显著减少。
现在有令人信服的证据表明，患有高危妊娠（包括先兆子痫和疑似宫内生长受限）的妇女应接受脐动脉波形的多普勒超声检查。
