o_1977r8vv9vk1ts2ms0kd8pksa.pdf

396 D. Maulik, R. Figueroa
Fig. 26.2. Proportional effect of Doppler ultrasonography on the number of dead babies (stillbirths and neonates) when
used for high-risk pregnancies. (Reprinted from [26] with permission)
Fig. 26.3. Effects of Doppler ultrasonography on perinatal outcome in high-risk pregnancies. Post hoc analysis (Reprinted
from [26] with permission)
Since the first systematic review of Alfirevic and
Neilson [26] subsequent systematic reviews have been
performed. Divon performed a meta-analysis of eight
published and peer-review randomized trials of 6,838
patients [27]. Umbilical artery Doppler studies significantly
decreased perinatal mortality (OR 0.66, CI
0.46±0.94). Divon concluded that there were enough
data to show the benefit of umbilical artery Doppler
velocimetry in high-risk patients and meta-analysis
of additional randomized controlled trials was unlikely
to change these results.
In 1996, Neilson and Alfirevic [28] reviewed 11
randomized controlled trials of 7,000 high-risk pregnancies.
The study by MacParland and Pearce [2] was
removed from this meta-analysis because the veracity
of the data presented was put into question. The use
of Doppler ultrasound was associated with a trend toward
a reduction in perinatal deaths (OR 0.71, 95%