Ali, S; Heuving, S; Kawooya, MG; Byamugisha, J; Grobbee, DE; Papageorghiou, AT; Klipstein-Grobusch, K; Rijken, MJ
(2021)
Prognostic accuracy of antenatal Doppler ultrasound for adverse perinatal outcomes in low-income and middle-income countries: a systematic review.
BMJ Open, 11 (12).
e049799.
ISSN 2044-6055
https://doi.org/10.1136/bmjopen-2021-049799
SGUL Authors: Papageorghiou, Aris
Abstract
OBJECTIVES: This systematic review examined available literature on the prognostic accuracy of Doppler ultrasound for adverse perinatal outcomes in low/middle-income countries (LMIC). DESIGN: We searched PubMed, Embase, Cochrane Library and Scopus from inception to April 2020. SETTING: Observational or interventional studies from LMICs. PARTICIPANTS: Singleton pregnancies of any risk profile. INTERVENTIONS: Umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR), uterine artery (UtA), fetal descending aorta (FDA), ductus venosus, umbilical vein and inferior vena cava. PRIMARY AND SECONDARY OUTCOME MEASURES: Perinatal death, stillbirth, neonatal death, expedited delivery for fetal distress, meconium-stained amniotic fluid, low birth weight, fetal growth restriction, admission to neonatal intensive care unit, neonatal acidosis, Apgar scores, preterm birth, fetal anaemia, respiratory distress syndrome, length of hospital stay, birth asphyxia and composite adverse perinatal outcomes (CAPO). RESULTS: We identified 2825 records, and 30 (including 4977 women) from Africa (40.0%, n=12), Asia (56.7%, n=17) and South America (3.3%, n=01) were included. Many individual studies reported associations and promising predictive values of UA Doppler for various adverse perinatal outcomes mostly in high-risk pregnancies, and moderate to high predictive values of MCA, CPR and UtA Dopplers for CAPO. A few studies suggested that the MCA and FDA may be potent predictors of fetal anaemia. No randomised clinical trial (RCT) was found. Most studies were of suboptimal quality, poorly powered and characterised by wide variations in outcome classifications, the timing for the Doppler tests and study populations. CONCLUSION: Local evidence to guide how antenatal Doppler ultrasound should be used in LMIC is lacking. Well-designed studies, preferably RCTs, are required. Standardisation of practice and classification of perinatal outcomes across countries, following the international standards, is imperative. PROSPERO REGISTRATION NUMBER: CRD42019128546.
Item Type: |
Article
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Additional Information: |
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
Keywords: |
fetal medicine, prenatal diagnosis, ultrasonography, ultrasound, Developing Countries, Female, Humans, Infant, Newborn, Middle Cerebral Artery, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Prognosis, Pulsatile Flow, Ultrasonography, Doppler, Ultrasonography, Prenatal, Middle Cerebral Artery, Humans, Ultrasonography, Doppler, Ultrasonography, Prenatal, Prognosis, Pregnancy Outcome, Predictive Value of Tests, Pregnancy, Pulsatile Flow, Developing Countries, Infant, Newborn, Female, ultrasound, prenatal diagnosis, ultrasonography, fetal medicine, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences |
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 ) |
Journal or Publication Title: |
BMJ Open |
ISSN: |
2044-6055 |
Language: |
eng |
Dates: |
Date | Event |
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2 December 2021 | Published | 11 November 2021 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
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PubMed ID: |
34857564 |
Web of Science ID: |
WOS:000726845300017 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/114784 |
Publisher's version: |
https://doi.org/10.1136/bmjopen-2021-049799 |
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