Systematic review and meta-analysis of middle cerebral artery Doppler to predict perinatal wellbeing.
OBJECTIVE
Identification of the fetus at risk of compromise is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving perinatal outcome. The accuracy of middle cerebral artery (MCA) Doppler for prediction of the fetus at risk of compromise of wellbeing is not known. The objective of this systematic review with bivariate meta-analysis was to evaluate the accuracy of middle cerebral artery Doppler for prediction of compromise of fetal/neonatal wellbeing.


METHODS
Systematic review and bivariate meta-analysis with searches of Medline, Embase, Cochrane library, Medion (inception to October 2011), hand searching of journal and reference lists, contact with experts. Two reviewers independently selected articles in which the results of middle cerebral artery Doppler were associated with the occurrence of compromise of fetal/neonatal wellbeing. There were no language restrictions applied.


RESULTS
Thirty-five studies, testing 4025 fetuses, met the selection criteria. Data were extracted on study characteristics, quality and results to construct 2×2 tables. Likelihood ratios for positive and negative test results, sensitivity, specificity and their 95% confidence intervals were generated for the different indices and thresholds. Meta-analysis showed low predictive accuracy. For prediction of adverse perinatal outcome and perinatal mortality the results were positive likelihood ratios 2.77 (1.93, 3.96) and 1.36 (1.10, 1.67) and negative likelihood ratios 0.58 (0.48, 0.69) and 0.51 (0.29, 0.89) respectively.


CONCLUSIONS
Abnormal middle cerebral artery Doppler showed limited predictive accuracy for compromise of fetal/neonatal wellbeing. High quality primary research or individual patient data meta-analysis looking at this test in combination with other tests is required.
School of Clinical and Experimental Medicine, University of Birmingham, Birmingham Women's Hospital, Birmingham B15 2TG, UK. r.k.morris@bham.ac.uk
R K
RK
Morris
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Say
S C
SC
Robson
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Kleijnen
K S
KS
Khan
D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D012306:Risk; D016216:Ultrasonography, Prenatal