Oros, D; Ruiz-Martinez, S; Staines-Urias, E; Conde-Agudelo, A; Villar, J; Fabre, E; Papageorghiou, AT
(2019)
Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review.
Ultrasound Obstet Gynecol, 53 (4).
pp. 454-464.
ISSN 1469-0705
https://doi.org/10.1002/uog.20102
SGUL Authors: Papageorghiou, Aris
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Abstract
OBJECTIVE: To assess studies reporting reference ranges for umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR), using a set of predefined methodological quality criteria for study design, statistical analysis and reporting methods. METHODS: This was a systematic review of observational studies in which the primary aim was to create reference ranges for UA and MCA Doppler indices and CPR in fetuses of singleton gestations. A search for relevant articles was performed in MEDLINE, EMBASE, CINAHL, Web of Science (from inception to 31 December 2016) and references of the retrieved articles. Two authors independently selected studies, assessed the risk of bias and extracted the data. Studies were scored against a predefined set of independently agreed methodological criteria and an overall quality score was assigned to each study. Linear multiple regression analysis assessing the association between quality scores and study characteristics was performed. RESULTS: Thirty-eight studies met the inclusion criteria. The highest potential for bias was noted in the following fields: 'ultrasound quality control measures', in which only two studies demonstrated a comprehensive quality-control strategy; 'number of measurements taken for each Doppler variable', which was apparent in only three studies; 'sonographer experience', in which no study on CPR reported clearly the experience or training of the sonographers, while only three studies on UA Doppler and four on MCA Doppler did; and 'blinding of measurements', in which only one study, on UA Doppler, reported that sonographers were blinded to the measurement recorded during the examination. Sample size estimations were present in only seven studies. No predictors of quality were found on multiple regression analysis. Reference ranges varied significantly with important clinical implications for what is considered normal or abnormal, even when restricting the analysis to the highest scoring studies. CONCLUSIONS: There is considerable methodological heterogeneity in studies reporting reference ranges for UA and MCA Doppler indices and CPR, and the resulting references have important implications for clinical practice. There is a need for the standardization of methodologies for Doppler velocimetry and for the development of reference standards, which can be correctly interpreted and applied in clinical practice. We propose a set of recommendations for this purpose. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Item Type: | Article | ||||||||
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Additional Information: | This is the peer reviewed version of the following article: Oros, D., Ruiz-Martinez, S., Staines-Urias, E., Conde-Agudelo, A., Villar, J., Fabre, E. and Papageorghiou, A.T. (2019), Reference ranges for Doppler indices of umbilical and fetal middle cerebral arteries and cerebroplacental ratio: systematic review. Ultrasound Obstet Gynecol, 53: 454-464, which has been published in final form at https://doi.org/10.1002/uog.20102. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited. | ||||||||
Keywords: | Doppler reference ranges, cerebroplacental ratio, fetal growth restriction, methodology, middle cerebral artery Doppler, small-for-gestational age, umbilical artery Doppler, Female, Gestational Age, Humans, Middle Cerebral Artery, Observational Studies as Topic, Observer Variation, Predictive Value of Tests, Pregnancy, Pulsatile Flow, Reference Values, Ultrasonography, Doppler, Ultrasonography, Prenatal, Umbilical Arteries, Middle Cerebral Artery, Umbilical Arteries, Humans, Observer Variation, Ultrasonography, Doppler, Ultrasonography, Prenatal, Predictive Value of Tests, Gestational Age, Pregnancy, Pulsatile Flow, Reference Values, Female, Observational Studies as Topic, cerebroplacental ratio, Doppler reference ranges, fetal growth restriction, methodology, middle cerebral artery Doppler, small-for-gestational age, umbilical artery Doppler, Doppler reference ranges, cerebroplacental ratio, fetal growth restriction, methodology, middle cerebral artery Doppler, small-for-gestational age, umbilical artery Doppler, Female, Gestational Age, Humans, Middle Cerebral Artery, Observational Studies as Topic, Observer Variation, Predictive Value of Tests, Pregnancy, Pulsatile Flow, Reference Values, Ultrasonography, Doppler, Ultrasonography, Prenatal, Umbilical Arteries, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE ) |
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Journal or Publication Title: | Ultrasound Obstet Gynecol | ||||||||
ISSN: | 1469-0705 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
PubMed ID: | 30126005 | ||||||||
Web of Science ID: | WOS:000463145000005 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/114034 | ||||||||
Publisher's version: | https://doi.org/10.1002/uog.20102 |
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