Johnstone F D, Prescott R, Hoskins P, Greer I A, McGlew T, Compton M
Department of Obstetrics and Gynaecology, Centre for Reproductive Biology, Edinburgh, UK.
Br J Obstet Gynaecol. 1993 Aug;100(8):733-41. doi: 10.1111/j.1471-0528.1993.tb14264.x.
To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results.
Randomised controlled trial.
A large teaching hospital.
Two thousand two hundred and eighty-nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring.
Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians.
Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of of fetal well being: cardiotocography, biophysical profile and ultrasound biometry.
The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P = 0.007) but no difference in the low risk group.
Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero-placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.
评估临床医生获取脐动脉多普勒超声检查结果对产科实践的影响。
随机对照试验。
一家大型教学医院。
2289例因转诊进行多普勒检查或胎儿监测而被确定为有风险的妊娠。
脐动脉连续波多普勒研究。检查结果立即提供给临床医生。
胎儿结局：围产期死亡率、阿氏评分及新生儿病房收治情况。产科干预措施：住院、引产及剖宫产。胎儿健康状况监测手段的使用情况：胎心监护、生物物理评分及超声生物测量。
治疗组和对照组在年龄、产次、入组时孕周及风险特征方面具有可比性。围产期结局、产科干预措施或胎儿监测手段的使用情况在总体上无差异。对仅因高血压或疑似胎儿生长受限而入选的一个亚组（n = 754）进行检查，同样显示组间随机化未产生差异。仅对那些回顾性定义为低风险和高风险的妊娠进行比较，结果显示在可获取多普勒检查结果的高风险组中，胎心监护的使用更多（P = 0.00７），而低风险组中无差异。
已证实脐动脉多普勒记录在产前胎儿窘迫的预测能力方面表现良好。本研究所考察的是临床医生对该检查的反应。结果表明，产科医生并未使用该检查来修改其风险评估，因此也未改变特定妊娠中胎儿监测的必要性。确实需要从非常大的数据集积累信息，尤其是关于多普勒检查对明显由慢性子宫 - 胎盘原因导致的产前胎儿窘迫的预测能力，以指导监测资源的使用。如果在广泛使用这些技术的医院中，仅将脐动脉多普勒记录添加到现有的胎儿监测技术中，那么目前它可能只会增加人员和费用等额外资源，而无益处。
