Intrapartum umbilical artery Doppler velocimetry as a predictor of adverse perinatal outcome: a systematic review.
OBJECTIVE
To evaluate the diagnostic prediction of intrapartum umbilical artery Doppler velocimetry for adverse perinatal outcomes using systematic quantitative overview of the available literature.


METHODS
Online searching of MEDLINE database (January 1966-September 1997), scanning of bibliography of known primary and review articles, review of recent journal issues and that from personal files. Study selection, assessment of study quality and data extraction were all performed in duplicate under masked conditions.


METHODS
2700 women (unselected, low, high, and combined low and high obstetric risk populations) included in eight studies selected for meta-analyses.


METHODS
Likelihood ratios (LRs) for positive and negative test results were generated for the following outcome measures: Apgar scores < 7 at 1 and 5 minute following delivery, small for gestational age fetus; intrapartum fetal heart rate abnormality, umbilical arterial acidosis at delivery; and caesarean section for fetal distress.


RESULTS
For Apgar score < 7 at 1 minute following delivery, the pooled LR was 2.5 (95% CI 1.7-3.7) for a positive test and 1.0 (95% CI 0.9-1.1) for a negative test result. A positive test predicted an Apgar score < 7 at 5 minute following delivery with a pooled LR of 1.3 (95% CI 0.4-4.1) while a negative test had a pooled LR of 1.0 (95% CI 0.8-1.2). For the prediction of a small for gestational age fetus, the pooled LR was 3.4 (95% CI 2.3-5.1) for a positive test and 0.9 (95% CI 0.8-1.0) for a negative test. The prediction for fetal heart rate abnormality during labour was similarly disappointing: the pooled LR for a positive test result was 1.4 (95% CI 0.9-1.2) whereas a negative test result generated a pooled LR of 0.9 (95% CI 0.9-1.0). With umbilical acidosis at delivery, the pooled LR was 1.6 (95% CI 1.1-2.5) for a positive test and 1.1 (95% CI 1.0-1.2) for a negative test. The LRs for the prediction of caesarean section for fetal distress were 4.1 (95% CI 2.7-6.2) for a positive test result and 0.9 (95% CI 0.8-1.0) for a negative test result.


CONCLUSIONS
Intrapartum umbilical artery Doppler velocimetry is a poor predictor of adverse perinatal outcomes.
Farrell
T
T
Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, Tayside, UK.
Chien
P F
PF
Gordon
A
A
D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D016013:Likelihood Functions; D018743:Perinatal Care; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D014469:Umbilical Arteries / Q000502:physiology*