J P Newnham1, M R O'Dea, K P Reid, D A Diepeveen. 1. University Department of Obstetrics and Gynaecology, King Edward Memorial Hospital for Women, Perth, Western Australia.
Abstract
OBJECTIVE: To test whether the introduction of Doppler waveform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management. DESIGN: A randomized controlled trial. SETTING: Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia. SUBJECTS:505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester. INTERVENTION: Continuous wave Doppler studies of umbilical and uteroplacental arterial circulations. Results were revealed to patients and clinicians. MAIN OUTCOME MEASURES: Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric interventions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care. RESULTS: There was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewer contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distress after induction of labour leading to emergency caesarean section. Depressed Apgar scores were more frequent in the study group. CONCLUSION: Introduction of Doppler waveform studies did not result in reduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice.
RCT Entities:
OBJECTIVE: To test whether the introduction of Doppler waveform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management. DESIGN: A randomized controlled trial. SETTING: Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia. SUBJECTS: 505 women with pregnancy abnormalities referred to an ultrasound department for fetal investigation during the third trimester. INTERVENTION: Continuous wave Doppler studies of umbilical and uteroplacental arterial circulations. Results were revealed to patients and clinicians. MAIN OUTCOME MEASURES: Principal end point was the duration of neonatal stay in hospital; other end points included the number and type of fetal heart rate monitoring studies, obstetric interventions, frequency of fetal distress, birthweight, Apgar scores and need for neonatal intensive care. RESULTS: There was no effect on the duration of neonatal stay in hospital. Small trends in obstetric management were observed with study group patients having fewer contraction stress tests, less likelihood of antepartum fetal distress, and more likelihood of fetal distress after induction of labour leading to emergency caesarean section. Depressed Apgar scores were more frequent in the study group. CONCLUSION: Introduction of Doppler waveform studies did not result in reduced neonatal morbidity but did have a small effect on obstetric management. For each institution the role of Doppler studies in late pregnancy will be influenced by the usage of other tests of fetal welfare already entrenched in clinical practice.