A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care

Abstract

OBJECTIVE: Our aim was to assess the clinical value of umbilical Doppler velocimetry with regard to maternal hospitalization policy, obstetric management, and perinatal outcome. STUDY DESIGN: We conducted a randomized controlled trial in a university hospital population. A total of 1598 women participated, of whom 809 were allocated to the Doppler group and 789 to the control group. In the Doppler group umbilical Doppler studies were performed only when indicated. Abnormal pulsatility index values prompted intensified (clinical) fetal monitoring. In the control group Doppler velocimetry was not available. RESULTS: The use of umbilical Doppler velocimetry did not show any clinical or economical benefit with regard to maternal admission rate and duration or neonatal admission policy and requirements of ventilatory support. Neither did the use of Doppler have any beneficial effect on obstetric management during labor and the occurrence of fetal distress during labor. In the control group a higher perinatal mortality rate was observed. In the Doppler group the risk ratio of perinatal mortality of fetuses and infants weighing ≥500 gm was 0.45 (95% confidence interval 0.21 to 0.94), as compared with the control group. Neonatal mortality was equal in both groups; therefore the reduction in perinatal mortality was not the result of a delay in timing of fetal death. CONCLUSION: Selective use of umbilical Doppler velocimetry in pregnancies “at fetal risk” may be of benefit in antenatal care by a reduction of perinatal mortality and especially late fetal mortality. (AM J OBSTET GYNECOL 1994;170:625-34.)