Systematic review and meta-analysis of the test accuracy of ductus venosus Doppler to predict compromise of fetal/neonatal wellbeing in high risk pregnancies with placental insufficiency.
OBJECTIVE
To evaluate the test accuracy of ductus venosus Doppler for prediction of compromise of fetal/neonatal wellbeing.


METHODS
The search strategy employed searching of electronic databases (Medline, Embase, Cochrane library, Medion) from inception to May 2009, hand searching of journal and reference lists, contact with experts. Two reviewers independently selected articles in which the results of ductus venosus Doppler were associated with the occurrence of compromise of fetal/neonatal wellbeing. There were no language restrictions applied. Data were extracted on study characteristics, quality and results to construct 2 x 2 tables. Likelihood ratios for positive and negative test results, sensitivity, specificity and their 95% confidence intervals were generated for the different indices and thresholds.


RESULTS
Eighteen studies, testing 2267 fetuses met the selection criteria, all performed in a high risk population with placental insufficiency in second/third trimester. Meta-analysis showed moderate predictive accuracy. The best result was for the prediction of perinatal mortality, positive likelihood ratio 4.21 (95% CI 1.98-8.96) and negative likelihood ratio 0.43 (95% CI 0.30-0.61). For prediction of adverse perinatal outcome the results were positive likelihood ratio 3.15 (95% CI 2.19-4.54) and negative likelihood ratio 0.49 (95% CI 0.40-0.59).


CONCLUSIONS
Abnormal ductus venosus Doppler showed moderate predictive accuracy for compromise of fetal/neonatal wellbeing overall and perinatal mortality in high risk pregnancies with placental insufficiency.
Morris
R Katie
RK
School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK. r.k.morris@bham.ac.uk
Selman
Tara J
TJ
Verma
Meenakshi
M
Robson
Stephen C
SC
Kleijnen
Jos
J
Khan
Khalid S
KS
D005260:Female; D047109:Fetal Development; D005316:Fetal Distress / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D018608:Ultrasonography, Doppler / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*