Third‐trimester uterine artery Doppler for prediction of adverse outcome in late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

• Published in: Ultrasound in obstetrics & gynecology 2020-05, Vol.55 (5), p.575-585
• Main Authors: Martinez‐Portilla, R. J., Caradeux, J., Meler, E., Lip‐Sosa, D. L., Sotiriadis, A., Figueras, F.
• Format: Article
• Language: English
• Subjects: Acidosis; adverse perinatal outcome; Apgar score; Bayesian analysis; Cesarean section; Conditional probability; Criteria; fetal growth restriction; Fetuses; Health risk assessment; Hysterectomy; Identification methods; Meta-analysis; Mortality; Neonates; perinatal death; Randomization; Risk assessment; SGA; Small for gestational age; Systematic review; Ultrasonic imaging; uterine artery Doppler; Uterus; Veins & arteries
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.21940

ABSTRACT Objective To investigate the predictive ability for adverse perinatal outcome of abnormal third‐trimester uterine artery Doppler in late small‐for‐gestational‐age (SGA) fetuses. Methods A systematic search was performed to identify relevant observational studies and randomized controlled trials evaluating the performance of abnormal third‐trimester uterine artery Doppler for the prediction of adverse perinatal outcome in suspected SGA fetuses and SGA neonates. Abnormal uterine artery Doppler was defined as uterine artery pulsatility index > 95th percentile or ≥ 2 SD above the mean, or bilateral uterine artery notching. Hierarchical summary receiver‐operating‐characteristics (ROC) curves were constructed using random‐effects modeling. Bayesian analysis was used to calculate the posterior probability of adverse perinatal outcome following an abnormal or normal uterine artery Doppler assessment. Results Seventeen observational studies (including 7552 fetuses either diagnosed with suspected SGA (n = 3461) or later diagnosed as a SGA neonate (n = 4091)) met the inclusion criteria; no randomized‐controlled trials met the inclusion criteria. Summary ROC curves showed that, among suspected SGA fetuses, the best predictive accuracy of abnormal third‐trimester uterine artery Doppler was for perinatal mortality and the worst was for composite adverse perinatal outcome, with areas under the summary ROC curves of 0.90 and 0.66, respectively. The corresponding positive and negative likelihood ratios were 16.5 and 0.6 for perinatal mortality and 2.82 and 0.65 for composite adverse perinatal outcome, respectively. Following an abnormal vs normal uterine artery Doppler assessment, the posterior risks for composite adverse perinatal outcome, admission to the neonatal intensive care unit, Cesarean section for intrapartum fetal compromise, 5‐min Apgar score