Doppler assessment of the fetus with intrauterine growth restriction
Objective We sought to provide evidence-based guidelines for utilization of Doppler studies for fetuses with intrauterine growth restriction (IUGR). Methods Relevant documents were identified using PubMed (US National Library of Medicine, 1983 through 2011) publications, written in English, which de...
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Published in | American journal of obstetrics and gynecology Vol. 206; no. 4; pp. 300 - 308 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Mosby, Inc
01.04.2012
Elsevier |
Subjects | |
Online Access | Get full text |
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Summary: | Objective We sought to provide evidence-based guidelines for utilization of Doppler studies for fetuses with intrauterine growth restriction (IUGR). Methods Relevant documents were identified using PubMed (US National Library of Medicine, 1983 through 2011) publications, written in English, which describe the peripartum outcomes of IUGR according to Doppler assessment of umbilical arterial, middle cerebral artery, and ductus venosus. Additionally, the Cochrane Library, organizational guidelines, and studies identified through review of the above were utilized to identify relevant articles. Consistent with US Preventive Task Force suggestions, references were evaluated for quality based on the highest level of evidence, and recommendations were graded. Results and Recommendations Summary of randomized and quasirandomized studies indicates that, among high-risk pregnancies with suspected IUGR, the use of umbilical arterial Doppler assessment significantly decreases the likelihood of labor induction, cesarean delivery, and perinatal deaths (1.2% vs 1.7%; relative risk, 0.71; 95% confidence interval, 0.52–0.98). Antepartum surveillance with Doppler of the umbilical artery should be started when the fetus is viable and IUGR is suspected. Although Doppler studies of the ductus venous, middle cerebral artery, and other vessels have some prognostic value for IUGR fetuses, currently there is a lack of randomized trials showing benefit. Thus, Doppler studies of vessels other than the umbilical artery, as part of assessment of fetal well-being in pregnancies complicated by IUGR, should be reserved for research protocols. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Instructional Material/Guideline-2 ObjectType-Feature-3 content type line 23 |
ISSN: | 0002-9378 1097-6868 |
DOI: | 10.1016/j.ajog.2012.01.022 |