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a Chapter 26 Doppler Velocimetry for Fetal Surveillance: Randomized Clinical Trials and Implications for Practice 399
environment is judged to be greater than that from
pulmonary immaturity.
It should be noted that this management approach
does not provide an answer for every contingency
that may develop. The physician must individualize
the care in the light of the myriad variations in the
clinical situation. This recommendation should be
used as a pragmatic guideline that integrates the new
modality with the existing standards of fetal surveillance.
As new evidence accumulates and our experience
grows, these guidelines may contribute to the
emergence of more effective standards of practice.
Obviously, this plan of management requires refinement
in the future so the issue of cost-effective integration
of the various modalities of fetal monitoring
in appropriate sequence and frequency may be addressed.
Moreover, the utility of in-depth hemodynamic
information, such as the middle cerebral arterial
Doppler index and the cerebroplacental ratio, requires
further investigation.
Conclusion
The development of Doppler sonography has made it
feasible to assess the fetal and uteroplacental circulations.
Numerous studies have established a significant
association between abnormal Doppler indices and
the various pregnancy disorders and adverse perinatal
outcomes. Most clinical investigations suggest that,
in high-risk pregnancies, umbilical arterial Doppler
indices may be efficacious for predicting perinatal
problems including fetal death. Many randomized
trials on Doppler velocimetry have yielded positive
results. Furthermore, systematic reviews of the trials
by meta-analysis demonstrate a significant reduction
in preventable fetal deaths. The current evidence
mandates that Doppler velocimetry of the umbilical
artery should be an integral component of fetal
surveillance in pregnancies complicated with fetal
growth restriction or preeclampsia. Obviously, no
single testing modality should be regarded as the
exclusive choice for fetal surveillance, as these tests
reveal different aspects of fetal pathophysiology, often
in a complementary manner.
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