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INTRAUTERINE GROWTH RESTRICTION |
Ultrasound Obstet Gynecol. 1997 Jan;9(1):6-13.
Doppler ultrasonography in suspected intrauterine growth retardation: a
randomized clinical trial.
Nienhuis SJ, Vles JS, Gerver WJ, Hoogland HJ.
Department of Obstetrics and Gynecology, University Hospital Maastricht, The
Netherlands.
A randomized clinical trial was performed to test the hypothesis that if
suspected intrauterine growth retardation (IUGR) is associated with normal
umbilical artery Doppler ultrasound findings, hospitalization can safely be
avoided. One hundred and fifty women with singleton pregnancies and
suspected IUGR were randomized between an intervention (n = 74) and a
control group (n = 76). In the intervention group, clinicians were strongly
requested not to hospitalize for suspected IUGR if the Doppler findings were
normal. In the control group, the Doppler results were not revealed and the
participants received the standard management for suspected IUGR. Endpoints
of the trial were: costs in terms of hospitalization, perinatal outcome,
neurological development, and postnatal growth. Duration of hospitalization
was significantly shorter in the intervention group than in the control
group. Contrary to expectations, the hospitalization rate during pregnancy
in the intervention group was not below that of the control group. This
negative finding was partly due to the admission of patients in the
intervention group despite their normal Doppler results. Moreover, the trial
might have induced a more critical attitude towards hospitalization in
suspected IUGR, decreasing admission in the control group. No clear
differences were found in perinatal outcome, neurological development, or
postnatal growth. The results suggest that normal umbilical artery Doppler
findings in suspected cases of IUGR justify outpatient management.
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