title: The Doppler assessment in multiple pregnancy randomised controlled trial of ultrasound biometry versus umbilical artery Doppler ultrasound and biometry in twin pregnancy.
abstract: OBJECTIVE
  To assess the addition value of umbilical artery Doppler ultrasound added to standard ultrasound biometry measurements in the management of twin pregnancies.
  
  
  METHODS
  A prospective randomised controlled multicentre trial of women with twin pregnancies.
  
  
  METHODS
  Tertiary level referral hospitals in Australia, New Zealand and Southeast Asia.
  
  
  METHODS
  Pregnant women with twin pregnancies.
  
  
  METHODS
  Women were randomised at 25 weeks of gestation to receive either standard ultrasound biometric assessment or standard assessment plus Doppler ultrasound umbilical artery flow velocity waveform analysis. The studies were repeated at 30 and 35 weeks unless otherwise indicated. Physicians were advised to institute close fetal surveillance in the presence of an abnormal umbilical artery Doppler study or with biometry indicators of fetal compromise.
  
  
  METHODS
  Standard obstetric (mode of delivery, perinatal mortality, hypertension, antenatal admissions and gestation at delivery) and neonatal (5 minute Apgar scores <5, admissions to neonatal nursery and requirements for ventilation) outcomes and statistical analysis was on intention-to-treat. There were no significant differences between the two groups with respect to demography, antenatal, peripartum and neonatal outcomes. There was no difference in the perinatal mortality rate in the no Doppler group (n = 264), which was 11/1000 live births, and the Doppler group (n = 262), which was 9/1000 live births. There were three unexplained intrauterine deaths in the no Doppler group and none in the Doppler group (OR 0.14, 95% CI 0.01-1.31). Two intrauterine deaths in the Doppler group were due to cord prolapse in labour and a fetomaternal haemorrhage, both very unlikely to be influenced by Doppler surveillance.
  
  
  CONCLUSIONS
  In this study, close surveillance in twin pregnancy resulted in a lower than expected fetal mortality from 25 weeks of gestation in both the no Doppler and Doppler groups. The lower rate of unexplained fetal death in the no Doppler group was not significantly different from the Doppler group.
authors.affiliation: Discipline of Reproductive Medicine and Mothers and Babies Research Centre, Faculty of Medicine and Health Sciences, University of Newcastle, New South Wales 2308, Callaghan, Australia.
authors.forename: Warwick
authors.initials: W
authors.lastname: Giles
authors.forename: Andrew
authors.initials: A
authors.lastname: Bisits
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Callaghan
authors.forename: Andrew
authors.initials: A
authors.lastname: Gill
mesh_terms: D000328:Adult; D001699:Biometry; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D014427:Twins; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology*