title: 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.
abstract: 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.
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK. r.k.morris@bham.ac.uk
authors.forename: R Katie
authors.initials: RK
authors.lastname: Morris
authors.forename: Tara J
authors.initials: TJ
authors.lastname: Selman
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Verma
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Robson
authors.forename: Jos
authors.initials: J
authors.lastname: Kleijnen
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
mesh_terms: 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*