title: Doppler ultrasound for fetal assessment in high risk pregnancies.
abstract: BACKGROUND
  Abnormal waveforms from Doppler ultrasound may indicate poor fetal prognosis. It is also possible that Doppler ultrasound could encourage inappropriate early delivery.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of Doppler ultrasound in high risk pregnancies on obstetric care and fetal outcomes.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group trials register.
  
  
  METHODS
  Randomised trials of Doppler ultrasound for the investigation of umbilical artery waveforms in high risk pregnancies compared to no Doppler ultrasound.
  
  
  METHODS
  Trial quality was assessed and data were extracted by both reviewers. Study authors were contacted for additional information.
  
  
  RESULTS
  Eleven studies involving nearly 7000 women were included. The trials were generally of good quality. Compared to no Doppler ultrasound, Doppler ultrasound in high risk pregnancy (especially those complicated by hypertension or presumed impaired fetal growth) was associated with a trend to a reduction in perinatal deaths (odds ratio 0.71, 95% confidence interval 0.50 to 1.01). The use of Doppler ultrasound was also associated with fewer inductions of labour (odds ratio 0.83, 95% confidence interval 0.74 to 0.93) and fewer admissions to hospital (odds ratio 0.56, 95% 0.43 to 0.72), without reports of adverse effects. No difference was found for fetal distress in labour (odds ratio 0.81, 95% confidence interval 0.59 to 1.13) or caesarean delivery (odds ratio 0.94, 95% 0.82 to 1.06).
  
  
  CONCLUSIONS
  The use of Doppler ultrasound in high risk pregnancies appears to improve a number of obstetric care outcomes and appears promising in helping to reducing perinatal deaths.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool, UK, L69 3BX. jneilson@liverpool.ac.uk
authors.forename: J P
authors.initials: JP
authors.lastname: Neilson
authors.forename: Z
authors.initials: Z
authors.lastname: Alfirevic
mesh_terms: D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D016032:Randomized Controlled Trials as Topic; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*