Amwj. Omtzigt et al., A RANDOMIZED CONTROLLED TRIAL ON THE CLINICAL-VALUE OF UMBILICAL DOPPLER VELOCIMETRY IN ANTENATAL CARE, American journal of obstetrics and gynecology, 170(2), 1994, pp. 625-634
OBJECTIVE: Our aim was to assess the clinical value of umbilical Doppl
er velocimetry with regard to maternal hospitalization policy, obstetr
ic management, and perinatal outcome. STUDY DESIGN: We conducted a ran
domized 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 Dop
pler 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 of economic
al benefit with regard to maternal admission rate and duration or neon
atal admission policy and requirements of ventilatory support. Neither
did the use of Doppler have any beneficial effect on obstetric manage
ment during labor and the occurrence of fetal distress during labor. I
n the control group a higher perinatal mortality rate was observed. In
the Doppler group the risk ratio of perinatal mortality of fetuses an
d infants weighing greater than or equal to 500 gm was 0.45 (95% confi
dence interval 0.21 to 0.94), as compared with the control group. Neon
atal mortality was equal in both groups; therefore the reduction in pe
rinatal mortality was not the result of a delay in timing of fetal dea
th. CONCLUSION: Selective use of umbilical Doppler velocimetry in preg
nancies ''at fetal risk'' may be of benefit in antenatal care by a red
uction of perinatal mortality and especially late fetal mortality.