Intrapartum umbilical artery Doppler velocimetry as a predictor of adverseperinatal outcome: a systematic review

Objective To evaluate the diagnostic prediction of intrapartum umbilical ar tery Doppler velocimetry for adverse perinatal outcomes using systematic qu antitative overview of the available literature. Design Online searching of MEDLINE database (January 1966-September 1997), scanning of bibliography of known primary and review articles, review of re cent journal issues and that from personal files. Study selection, assessme nt of study quality and data extraction were all performed in duplicate und er masked conditions. Participants 2700 women (unselected, low, high, and combined low and high o bstetric risk populations) included in eight studies selected for meta-anal yses. Main outcome measures Likelihood ratios (LRs) for positive and negative tes t results were generated for the following outcome measures: Apgar scores < 7 at 1 and 5 minute following delivery, small for gestational age fetus; i ntrapartum fetal heart rate abnormality, umbilical arterial acidosis at del ivery; and caesarean section for fetal distress. Results For Apgar score < 7 at 1 minute following delivery, the pooled LR w as 2.5 (95% CI 1.7-3.7) for a positive test and 1.0 (95% CI 0.9-1.1) for a negative test result. A positive test predicted an Apgar score < 7 at 5 min ute following delivery with a pooled LR of 1.3 (95% CI 0.4-4.1) while a neg ative test had a pooled LR of 1.0 (95% CI 0.8-1.2). For the prediction of a small for gestational age fetus, the pooled LR was 3.4 (95% CI 2.3-5.1) fo r a positive test and 0.9 (95% CI 0.8-1.0) for a negative test. The predict ion for fetal heart rate abnormality during labour was similarly disappoint ing: the pooled LR for a positive test result was 1.4 (95% CI 0.9-1.2) wher eas a negative test result generated a pooled LR of 0.9 (95% CI 0.9-1.0). W ith umbilical acidosis at delivery, the pooled LR was 1.6 (95% CI 1.1-2.5) for a positive test and 1.1 (95% CI 1.0-1.2) for a negative test. The LRs f or the prediction of caesarean section for fetal distress were 4.1 (95% CI 2.7-6.2) for a positive test result and 0.9 (95% CI 0.8-1.0) for a negative test result. Conclusion Intrapartum umbilical artery Doppler velocimetry is a poor predi ctor of adverse perinatal outcomes.