Table 5 Impact of uterine artery Doppler velocimetry on stillbirth and perinatal mortality

Papageorghiou et al. 2002 [44]

Multiple sites.

Review. 15 studies of routine Doppler assessments in pregnancy in unselected populations.

Sought to relate the risk of antepartum stillbirth to uterine artery Doppler flow velocimetry at 22–24 weeks.

Fetal growth restriction and perinatal death associated with impeded uterine artery flow.

Positive Doppler diagnosis appropriately identified ~40% of women who subsequently developed pre-eclampsia (6-fold increased risk with positive Doppler) and ~20% of fetal growth restriction cases (3.5-fold increased risk)

Intervention studies

Subtil et al; Essai Régional Aspirine Mère-Enfant (ERASME) Collaborative Group 2003. [46]

France and Belgium.

Multicentre RCT. Nulliparous women (N = 1853; N = 1253 intervention, N = 617 controls) 14–20 wks gestation.

Compared the impact of uterine Doppler (intervention) versus placebo (controls) on PMR. Women with abnormal Doppler waveforms received 100 mg of aspirin daily from Doppler exam until 36 wks.

PMR: RR = 4.02 (95% CI: 0.5–32.0) [NS]

[8/1249 (0.6%) vs. 1/327 (0.2%) in intervention vs. control groups, respectively].

Observational studies

Smith et al. 2007 [45]

UK.

Observational study. Unselected women (N = 30,519) who had uterine artery Doppler performed 22–24 wks of gestation.

Studied the relationship between abnormal (mean pulsatility index in the top decile and a bilateral notch) vs. normal Doppler flow on the risk of antepartum stillbirth.

Antepartum SBR: adj. HR = 5.5 (95% CI: 2.8–10.6) in Doppler with mean pulsatility index in the top decile vs. controls.

Antepartum SBR: adj. HR = 3.9 (95% CI: 2.0–7.8) in Doppler with a bilateral notch versus controls.

Unexplained SBR: adj. HR 2.5 (95% CI: 1.1–5.6) in Doppler with mean pulsatility index in the top decile vs. controls. No association between Doppler with a bilateral notch and SB.