[Clinical value of umbilical Doppler. Results of controlled trials in high risk and low risk populations].
OBJECTIVE
In order to assess the clinical utility of the use of arterial umbilical Doppler velocimetry, we performed meta-analysis in high and low-risk pregnancies with randomized controlled trials. We included in the low-risk meta-analysis the data of the french multicentric study submit to publication.


METHODS
Exhaustive review of published and non published trials was performed; quality of trials was assessed before inclusion in meta-analysis. Mantel-Haenzel statistic method was used. We used odds ratio with 95% confidence interval (CI) to present results.


RESULTS
Meta-analysis in the high-risk population performed with 13 trials (n = 9162) shows a 36% significant reduction in perinatal-deaths in the Doppler group. The reduction in deaths was also observed in perinatal deaths after exclusion of lethal malformation (OR = 0.62, CI:[0.45; 0.86]) and in stillbirths (OR = 0.54, CI:[0.29; 0.91]). There is no difference in maternal, obstetrical and other perinatal outcomes. Meta-analysis in the low-risk population performed with 4 trials (n = 11451) does not show any benefit in the Doppler group, in particular in perinatal deaths (OR = 0.90, Cl:[0.50; 1.60]).


CONCLUSIONS
Use of umbilical Doppler velocimetry in high-risk pregnancies involve a one third reduction in perinatal mortality. This proved effect should induce obstetricians to performed systematically an umbilical Doppler in pregnancies "at fetal risk". On the other hand, there is no indication to perform an umbilical Doppler in an unselected or a low-risk population.
Goffinet
F
F
Unité INSERM 149, Paris.
Paris
J
J
Nisand
I
I
Bréart
G
G
D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012107:Research Design; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
Utilité clinique du Doppler ombilical. Résultats des essais contrôlés en population à haut risque et à bas risque.