SCREENING FOR THE COMPROMISED FETUS - A RANDOMIZED TRIAL OF UMBILICALARTERY VELOCIMETRY IN UNSELECTED PREGNANCIES

OBJECTIVE: Meta-analysis of randomized trials of Doppler ultrasonograp hy in high-risk pregnancies has shown reduced mortality rates among no rmally formed fetuses. This trial addressed the impact on outcome of u mbilical artery velocimetry in a nonselected population (i.e., as a sc reening test in low-risk and high-risk pregnancies). STUDY DESIGN: A r andomized, controlled trial with Doppler ultrasonographic investigatio n was performed at two gestational age windows: 26 to 30 weeks and 34 to 36 weeks. The 2986 women were randomly allocated to revealed or con cealed groups in which the Doppler results were either made available or not made available to clinicians; 1056 women were studied at only t he first window, 544 at only the second, and 1386 at both. RESULTS: Th ere were no significant differences between groups in antenatal admiss ions to hospital, preterm deliveries, rates of cesarean section, admis sion to the neonatal unit, and need for assisted ventilation. There wa s, however, a trend toward fewer stillbirths in the ''revealed'' group (three vs eight, odds ratio 0.34, confidence interval 0.10 to 1.07). CONCLUSIONS: The incidence of stillbirths was reduced by more than hal f in the Doppler-revealed group, but the confidence intervals were wid e and these findings could be compatible with chance.