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INTRAUTERINE GROWTH RESTRICTION |
Br J Obstet Gynaecol. 1994 Feb;101(2):114-20.
The role of Doppler velocimetry in the management of high risk pregnancies.
Pattinson RC, Norman K, Odendaal HJ.
Department of Obstetrics and Gynaecology, University of Stellenbosch,
Parowvallei, Cape Province, South Africa.
Objectives:
To determine whether knowledge of the result of Doppler
velocimetry of the umbilical artery is beneficial to the management of a
high risk pregnancy.
Design:
Randomised controlled trial. The trial was of
the management type, designed to assess benefit accruing from additional
information supplied by Doppler velocimetry.
Setting:
Tygerberg Hospital,
Cape Town, South Africa. The hospital serves a population from the lower
socio-economic groups. SUBJECTS: Women with pregnancies 28 or more weeks
gestation with hypertensive diseases and/or suspected small for gestational
age fetuses were referred for Doppler velocimetry. From this population,
three subsets were formed: 1. those with fetuses with absent end-diastolic
velocities (20 fetuses); 2. those with hypertension but with fetuses with
end-diastolic velocities (89 fetuses); and 3. those with fetuses suspected
of being small for gestational age but with end-diastolic velocities (104
fetuses). INTERVENTIONS: Doppler velocimetry on all subjects. The study
group consisted of 10 cases with absent end-diastolic velocities, 47 cases
with hypertensive diseases with end-diastolic velocities and 51 cases with
suspected small for gestational age fetuses but with end-diastolic
velocities in which the result was revealed to the clinician. The control
group consisted of 10, 42 and 53 cases, respectively, in which the Doppler
results were not revealed. All other routine investigations (sonar and
antenatal fetal heart rate monitoring) were available to the clinicians.
Standard management protocols were followed in all groups. MAIN OUTCOME
MEASURES: Perinatal mortality and morbidity, antenatal hospitalisation,
maternal intervention, admission to the neonatal intensive care unit and
hospitalisation until discharge from the neonatal wards.
Results:
In the
study and control groups the gestational age at entry to the study, maternal
age, parity and various complications were not significantly different. In
the subset with absent end-diastolic velocities, there was one neonatal
death in the study group, but in the control group there were six deaths,
five intrauterine and one perinatally related infant death (P = 0.029).
Because of this significant finding, the study was stopped. There were no
differences in outcome in the subset where there was hypertensive disease
with end-diastolic velocities between the study and control groups. In the
subset in which small for gestational age fetuses were suspected, but in
which end-diastolic velocities were present, the women in the study group
had significantly fewer days in hospital before delivery (P < 0.001) and
tended to have fewer maternal interventions (study group = 27%, control
group = 43%; P = 0.07; odds ratio (OR) 0.49, 95% confidence limits (CL) 0.2
and 1.25) and caesarean sections (study group = 13%, control group = 27%; P
= 0.08; OR 0.43, 95% CL 0.14 and 1.32). The infants of the study group in
this subset also spent significantly less time in the neonatal wards (P =
0.029).
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