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Cochrane Database of Systematic Reviews

Fetal and umbilical Doppler ultrasound in high‐risk pregnancies

Information

DOI:
https://doi.org/10.1002/14651858.CD007529.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 13 June 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Zarko Alfirevic

    Correspondence to: Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK

    [email protected]

  • Tamara Stampalija

    Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy

  • Therese Dowswell

    Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK

Contributions of authors

In an earlier version of this review, T Stampalija (TS) drafted the background section, with Z Alfirevic (ZA) providing comments and suggestions. In this update, T Dowswell (TD) assisted with assessing new studies, grading the evidence and producing the 'Summary of findings' table. All authors commented on drafts.

Sources of support

Internal sources

  • The University of Liverpool, UK.

External sources

  • National Institute for Health Research (NIHR), UK.

    NIHR Cochrane Programme Grant Project: 13/89/05 – Pregnancy and childbirth systematic reviews to support clinical guidelines

Declarations of interest

Zarko Alfirevic: none known.

Tamara Stampalija: none known.

Therese Dowswell: I am paid via my institution by the UK NHS (NIHR programme grant) to work on a range of Cochrane Reviews. In the last 36 months, I have received funding from the WHO to work on other Cochrane reviews. The funders have no influence on the content or conclusions of the reviews I work on.

Acknowledgements

In the previous version of this review, Alfirevic 2010, Gill Gyte was supported by the NIHR NHS Cochrane Collaboration Programme grant scheme award for NHS‐prioritised centrally‐managed, pregnancy and childbirth systematic reviews: CPGS02. We thank Gill for her contributions to previous versions of this review.

This project was supported by the National Institute for Health Research, via Cochrane programme grant funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Therese Dowswell is supported by the NIHR Cochrane Programme Grant Project: 13/89/05 – Pregnancy and childbirth systematic reviews to support clinical guidelines.

Version history

Published

Title

Stage

Authors

Version

2017 Jun 13

Fetal and umbilical Doppler ultrasound in high‐risk pregnancies

Review

Zarko Alfirevic, Tamara Stampalija, Therese Dowswell

https://doi.org/10.1002/14651858.CD007529.pub4

2013 Nov 12

Fetal and umbilical Doppler ultrasound in high‐risk pregnancies

Review

Zarko Alfirevic, Tamara Stampalija, Gillian ML Gyte

https://doi.org/10.1002/14651858.CD007529.pub3

2010 Jan 20

Fetal and umbilical Doppler ultrasound in high‐risk pregnancies

Review

Zarko Alfirevic, Tamara Stampalija, Gillian ML Gyte

https://doi.org/10.1002/14651858.CD007529.pub2

2009 Jan 21

Fetal and umbilical Doppler ultrasound in high‐risk pregnancies

Protocol

Zarko Alfirevic, Tamara Stampalija, Gillian ML Gyte, James P Neilson

https://doi.org/10.1002/14651858.CD007529

Differences between protocol and review

The secondary outcome of 'any perinatal death after randomisation excluding malformations' was changed to 'any potentially preventable perinatal death', which was defined as 'perinatal death excluding chromosomal abnormalities, termination of pregnancies, birth before fetal viability (less than 500 g) and fetal death before use of the intervention'.

The methods have been updated to the current Cochrane Pregnancy and Childbirth Group standard text, and a 'summary of findings' table has been added to the updated review.

We included the following clinically relevant outcomes that were not prespecified in our protocol.

  • Antenatal admissions.

  • Birth less than 34 weeks.

  • Phototherapy for neonatal jaundice.

  • Abnormal neurological development at nine months.

  • Hospitalisation for IUGR neonatal.

  • Fetal distress in labour.

  • Birthweight < 5 percentile.

  • Periventricular leucomalacia.

  • Antenatal hospital stay (days).

  • Infant survival at two years.

  • Sepsis (proven).

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figures and Tables -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.1 Any perinatal death after randomisation.
Figures and Tables -
Figure 3

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.1 Any perinatal death after randomisation.

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.8 Cesarean section (elective and emergency).
Figures and Tables -
Figure 4

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.8 Cesarean section (elective and emergency).

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.9 Cesarean section ‐ elective.
Figures and Tables -
Figure 5

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.9 Cesarean section ‐ elective.

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.10 Cesarean section ‐ emergency.
Figures and Tables -
Figure 6

Funnel plot of comparison: 1 Doppler ultrasound versus no Doppler ultrasound, outcome: 1.10 Cesarean section ‐ emergency.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 1.1

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 1 Any perinatal death after randomisation.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 2 Serious neonatal morbidity.
Figures and Tables -
Analysis 1.2

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 2 Serious neonatal morbidity.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 3 Stillbirth.
Figures and Tables -
Analysis 1.3

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 3 Stillbirth.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 4 Neonatal death.
Figures and Tables -
Analysis 1.4

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 4 Neonatal death.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 5 Any potentially preventable perinatal death*.
Figures and Tables -
Analysis 1.5

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 5 Any potentially preventable perinatal death*.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 6 Apgar < 7 at 5 minutes.
Figures and Tables -
Analysis 1.6

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 6 Apgar < 7 at 5 minutes.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 7 Caesarean section (elective and emergency).
Figures and Tables -
Analysis 1.7

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 7 Caesarean section (elective and emergency).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 8 Caesarean section ‐ elective.
Figures and Tables -
Analysis 1.8

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 8 Caesarean section ‐ elective.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 9 Caesarean section ‐ emergency.
Figures and Tables -
Analysis 1.9

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 9 Caesarean section ‐ emergency.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 10 Spontaneous vaginal birth.
Figures and Tables -
Analysis 1.10

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 10 Spontaneous vaginal birth.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 11 Operative vaginal birth.
Figures and Tables -
Analysis 1.11

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 11 Operative vaginal birth.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 12 Induction of labour.
Figures and Tables -
Analysis 1.12

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 12 Induction of labour.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 13 Infant requiring intubation/ventilation.
Figures and Tables -
Analysis 1.13

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 13 Infant requiring intubation/ventilation.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 14 Neonatal fitting/seizures.
Figures and Tables -
Analysis 1.14

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 14 Neonatal fitting/seizures.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 15 Preterm labour.
Figures and Tables -
Analysis 1.15

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 15 Preterm labour.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 16 Gestational age at birth (weeks).
Figures and Tables -
Analysis 1.16

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 16 Gestational age at birth (weeks).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 17 Infant respiratory distress syndrome (RDS).
Figures and Tables -
Analysis 1.17

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 17 Infant respiratory distress syndrome (RDS).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 18 Neonatal admission to SCBU and/or NICU.
Figures and Tables -
Analysis 1.18

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 18 Neonatal admission to SCBU and/or NICU.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 19 Hypoxic ischaemic encephalopathy.
Figures and Tables -
Analysis 1.19

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 19 Hypoxic ischaemic encephalopathy.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 20 Intraventricular haemorrhage.
Figures and Tables -
Analysis 1.20

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 20 Intraventricular haemorrhage.

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 21 Birthweight (grams).
Figures and Tables -
Analysis 1.21

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 21 Birthweight (grams).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 22 Length of infant hospital stay (days).
Figures and Tables -
Analysis 1.22

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 22 Length of infant hospital stay (days).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 23 Birth < 34 weeks (not prespecified).
Figures and Tables -
Analysis 1.23

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 23 Birth < 34 weeks (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 24 Antenatal admissions (not prespecified).
Figures and Tables -
Analysis 1.24

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 24 Antenatal admissions (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 25 Phototherapy for neonatal jaundice (not prespecified).
Figures and Tables -
Analysis 1.25

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 25 Phototherapy for neonatal jaundice (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 26 Abnormal neurological development at 9 months (not prespecified).
Figures and Tables -
Analysis 1.26

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 26 Abnormal neurological development at 9 months (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 27 Hospitalisation for IUGR neonatal (not prespecified).
Figures and Tables -
Analysis 1.27

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 27 Hospitalisation for IUGR neonatal (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 28 Fetal distress in labour (not prespecified).
Figures and Tables -
Analysis 1.28

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 28 Fetal distress in labour (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 29 Birthweight < 5 percentile (not prespecified).
Figures and Tables -
Analysis 1.29

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 29 Birthweight < 5 percentile (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 30 Periventricular leucomalacia (not prespecified).
Figures and Tables -
Analysis 1.30

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 30 Periventricular leucomalacia (not prespecified).

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 31 Antenatal hospital stay (days) (not prespecified).
Figures and Tables -
Analysis 1.31

Comparison 1 Umbilical artery Doppler ultrasound versus no Doppler ultrasound, Outcome 31 Antenatal hospital stay (days) (not prespecified).

Comparison 2 Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups), Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 2.1

Comparison 2 Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups), Outcome 1 Any perinatal death after randomisation.

Comparison 2 Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups), Outcome 2 Serious neonatal morbidity.
Figures and Tables -
Analysis 2.2

Comparison 2 Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups), Outcome 2 Serious neonatal morbidity.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 3.1

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 1 Any perinatal death after randomisation.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 2 Stillbirth.
Figures and Tables -
Analysis 3.2

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 2 Stillbirth.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 3 Neonatal death.
Figures and Tables -
Analysis 3.3

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 3 Neonatal death.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 4 Any potentially preventable perinatal death*.
Figures and Tables -
Analysis 3.4

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 4 Any potentially preventable perinatal death*.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 5 Apgar < 7 at 5 minutes.
Figures and Tables -
Analysis 3.5

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 5 Apgar < 7 at 5 minutes.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 6 Caesarean section (elective and emergency).
Figures and Tables -
Analysis 3.6

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 6 Caesarean section (elective and emergency).

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 7 Caesarean section ‐ elective.
Figures and Tables -
Analysis 3.7

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 7 Caesarean section ‐ elective.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 8 Caesarean section ‐ emergency.
Figures and Tables -
Analysis 3.8

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 8 Caesarean section ‐ emergency.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 9 Spontaneous vaginal birth.
Figures and Tables -
Analysis 3.9

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 9 Spontaneous vaginal birth.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 10 Operative vaginal birth.
Figures and Tables -
Analysis 3.10

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 10 Operative vaginal birth.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 11 Induction of labour.
Figures and Tables -
Analysis 3.11

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 11 Induction of labour.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 12 Infant requiring intubation/ventilation.
Figures and Tables -
Analysis 3.12

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 12 Infant requiring intubation/ventilation.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 13 Neonatal fitting/seizures.
Figures and Tables -
Analysis 3.13

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 13 Neonatal fitting/seizures.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 14 Gestational age at birth.
Figures and Tables -
Analysis 3.14

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 14 Gestational age at birth.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 15 Neonatal admission to SCBU and/or NICU.
Figures and Tables -
Analysis 3.15

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 15 Neonatal admission to SCBU and/or NICU.

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 16 Infant birthweight (grams).
Figures and Tables -
Analysis 3.16

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 16 Infant birthweight (grams).

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 17 Length of infant hospital stay (days).
Figures and Tables -
Analysis 3.17

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 17 Length of infant hospital stay (days).

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 18 Antenatal admissions (not prespecified).
Figures and Tables -
Analysis 3.18

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 18 Antenatal admissions (not prespecified).

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 19 Phototherapy for neonatal jaundice (not prespecified).
Figures and Tables -
Analysis 3.19

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 19 Phototherapy for neonatal jaundice (not prespecified).

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 20 Antenatal hospital stay (days) (not prespecified).
Figures and Tables -
Analysis 3.20

Comparison 3 Umbilical artery Doppler ultrasound alone versus CTG alone, Outcome 20 Antenatal hospital stay (days) (not prespecified).

Comparison 4 Umbilical artery Doppler ultrasound alone versus CTG alone (all subgroups), Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 4.1

Comparison 4 Umbilical artery Doppler ultrasound alone versus CTG alone (all subgroups), Outcome 1 Any perinatal death after randomisation.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 5.1

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 1 Any perinatal death after randomisation.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 2 Survival following severe neonatal morbidity.
Figures and Tables -
Analysis 5.2

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 2 Survival following severe neonatal morbidity.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 3 Stillbirth.
Figures and Tables -
Analysis 5.3

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 3 Stillbirth.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 4 Neonatal death.
Figures and Tables -
Analysis 5.4

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 4 Neonatal death.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 5 Any potentially preventable perinatal death*.
Figures and Tables -
Analysis 5.5

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 5 Any potentially preventable perinatal death*.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 6 Fetal acidosis.
Figures and Tables -
Analysis 5.6

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 6 Fetal acidosis.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 7 Apgar < 7 at 5 minutes.
Figures and Tables -
Analysis 5.7

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 7 Apgar < 7 at 5 minutes.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 8 Infant requiring intubation/ventilation.
Figures and Tables -
Analysis 5.8

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 8 Infant requiring intubation/ventilation.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 9 Intraventricular haemorrhage.
Figures and Tables -
Analysis 5.9

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 9 Intraventricular haemorrhage.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 10 Bronchopulmonary dysplasia.
Figures and Tables -
Analysis 5.10

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 10 Bronchopulmonary dysplasia.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 11 Necrotising enterocolitis.
Figures and Tables -
Analysis 5.11

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 11 Necrotising enterocolitis.

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 12 Infant birthweight (grams).
Figures and Tables -
Analysis 5.12

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 12 Infant birthweight (grams).

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).
Figures and Tables -
Analysis 5.13

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).
Figures and Tables -
Analysis 5.14

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).
Figures and Tables -
Analysis 5.15

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 16 Sepsis (proven) (not prespecified).
Figures and Tables -
Analysis 5.16

Comparison 5 Early ductus venosus Doppler ultrasound versus CTG, Outcome 16 Sepsis (proven) (not prespecified).

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 6.1

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 1 Any perinatal death after randomisation.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 2 Survival following severe neonatal morbidity.
Figures and Tables -
Analysis 6.2

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 2 Survival following severe neonatal morbidity.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 3 Stillbirth.
Figures and Tables -
Analysis 6.3

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 3 Stillbirth.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 4 Neonatal death.
Figures and Tables -
Analysis 6.4

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 4 Neonatal death.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 5 Any potentially preventable perinatal death*.
Figures and Tables -
Analysis 6.5

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 5 Any potentially preventable perinatal death*.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 6 Fetal acidosis.
Figures and Tables -
Analysis 6.6

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 6 Fetal acidosis.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 7 Apgar < 7 at 5 minutes.
Figures and Tables -
Analysis 6.7

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 7 Apgar < 7 at 5 minutes.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 8 Infant requiring intubation/ventilation.
Figures and Tables -
Analysis 6.8

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 8 Infant requiring intubation/ventilation.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 9 Intraventricular haemorrhage.
Figures and Tables -
Analysis 6.9

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 9 Intraventricular haemorrhage.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 10 Bronchopulmonary dysplasia.
Figures and Tables -
Analysis 6.10

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 10 Bronchopulmonary dysplasia.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 11 Necrotising enterocolitis.
Figures and Tables -
Analysis 6.11

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 11 Necrotising enterocolitis.

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 12 Infant birthweight (grams).
Figures and Tables -
Analysis 6.12

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 12 Infant birthweight (grams).

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).
Figures and Tables -
Analysis 6.13

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).
Figures and Tables -
Analysis 6.14

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).
Figures and Tables -
Analysis 6.15

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 16 Sepsis (proven) (not prespecified).
Figures and Tables -
Analysis 6.16

Comparison 6 Late ductus venosus Doppler ultrasound versus CTG, Outcome 16 Sepsis (proven) (not prespecified).

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 1 Any perinatal death after randomisation.
Figures and Tables -
Analysis 7.1

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 1 Any perinatal death after randomisation.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 2 Survival following severe neonatal morbidity.
Figures and Tables -
Analysis 7.2

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 2 Survival following severe neonatal morbidity.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 3 Stillbirth.
Figures and Tables -
Analysis 7.3

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 3 Stillbirth.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 4 Neonatal death.
Figures and Tables -
Analysis 7.4

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 4 Neonatal death.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 5 Any potentially preventable perinatal death*.
Figures and Tables -
Analysis 7.5

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 5 Any potentially preventable perinatal death*.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 6 Fetal acidosis.
Figures and Tables -
Analysis 7.6

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 6 Fetal acidosis.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 7 Apgar < 7 at 5 minutes.
Figures and Tables -
Analysis 7.7

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 7 Apgar < 7 at 5 minutes.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 8 Infant requiring intubation/ventilation.
Figures and Tables -
Analysis 7.8

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 8 Infant requiring intubation/ventilation.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 9 Intraventricular haemorrhage.
Figures and Tables -
Analysis 7.9

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 9 Intraventricular haemorrhage.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 10 Bronchopulmonary dysplasia.
Figures and Tables -
Analysis 7.10

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 10 Bronchopulmonary dysplasia.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 11 Necrotising enterocolitis.
Figures and Tables -
Analysis 7.11

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 11 Necrotising enterocolitis.

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 12 Infant birthweight (grams).
Figures and Tables -
Analysis 7.12

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 12 Infant birthweight (grams).

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).
Figures and Tables -
Analysis 7.13

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 13 Long‐term infant neurodevelopmental outcome (impairment at 2 years).

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).
Figures and Tables -
Analysis 7.14

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years).

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).
Figures and Tables -
Analysis 7.15

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified).

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 16 Sepsis (proven) (not prespecified).
Figures and Tables -
Analysis 7.16

Comparison 7 Early ductus venosus Doppler ultrasound versus late, Outcome 16 Sepsis (proven) (not prespecified).

Summary of findings for the main comparison. Umbilical artery Doppler ultrasound compared to no Doppler ultrasound in high‐risk pregnancies

Umbilical artery Doppler ultrasound compared to no Doppler ultrasound in high‐risk pregnancies

Patient or population: pregnant women at increased risk of fetal complications
Setting: antenatal clinics or inpatient wards in hospitals in Australia (3) UK (6) US (2) Sweden (1) South Africa (2) Ireland (1) The Netherlands (1) France (1) Canada (1)
Intervention: umbilical artery Doppler ultrasound
Comparison: no Doppler ultrasound

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no Doppler ultrasound

Risk with umbilical artery Doppler ultrasound

Any perinatal death after randomisation

Study population

RR 0.71
(0.52 to 0.98)

10225
(16 RCTs)

⊕⊕⊕⊝
MODERATE 1 2

17 per 1000

12 per 1000
(9 to 17)

Serious neonatal morbidity

Study population

1098
(3 RCTs)

⊕⊝⊝⊝
VERY LOW 1 3 4

We did not pool the data for this outcome due to high heterogeneity (the direction of effect in the 2 studies contributing data were not consistent).

Stillbirth

Study population

RR 0.65
(0.41 to 1.04)

9560
(15 RCTs)

⊕⊕⊝⊝
LOW 1 2 5

9 per 1000

6 per 1000
(4 to 9)

Apgar < 7 at 5 minutes

Study population

RR 0.92
(0.69 to 1.24)

6321
(7 RCTs)

⊕⊕⊝⊝
LOW 1 5

29 per 1000

26 per 1000
(20 to 36)

Caesarean section (elective and emergency)

Study population

RR 0.90
(0.84 to 0.97)

7918
(14 RCTs)

⊕⊕⊕⊝
MODERATE 1 2

263 per 1000

237 per 1000
(221 to 255)

Induction of labour

Study population

RR 0.89
(0.80 to 0.99)

5633
(10 RCTs)

⊕⊕⊕⊝
MODERATE 1 2

334 per 1000

298 per 1000
(268 to 331)

Long‐term infant neurodevelopmental outcome (impairment at 2 years)

Study population

(0 studies)

There has been no comparative long‐term follow‐up of babies exposed to Doppler ultrasound in pregnancy in women at increased risk of complications.

see comment

see comment

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 All studies assessed as having design limitations due to lack of information.

2 Although there was some evidence of funnel plot asymmetry suggesting small‐study effect (with studies with smaller sample sizes appearing to have a more pronounced effect), we did not downgrade for publication bias because, for our selected outcomes, individual studies did not reach statistical significance and there was low heterogeneity across all studies for this outcome.

3 High heterogeneity (I² statistic 76%) with direction of effect different in the 2 studies contributing data.

4 95% CI crossing the line of no effect. Low event rate.

5 Wide 95% CI crossing the line of no effect.

Figures and Tables -
Summary of findings for the main comparison. Umbilical artery Doppler ultrasound compared to no Doppler ultrasound in high‐risk pregnancies
Comparison 1. Umbilical artery Doppler ultrasound versus no Doppler ultrasound

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

16

10225

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.52, 0.98]

1.1 Singleton pregnancy

9

4661

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.35, 1.01]

1.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.32, 2.41]

1.3 Singleton plus multiple pregnancies, or not stated

6

4512

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.51, 1.19]

2 Serious neonatal morbidity Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Singleton pregnancy

1

500

Risk Ratio (M‐H, Random, 95% CI)

0.13 [0.02, 0.99]

2.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Singleton plus multiple pregnancies, or not stated

2

598

Risk Ratio (M‐H, Random, 95% CI)

2.95 [0.31, 28.14]

3 Stillbirth Show forest plot

15

9560

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.41, 1.04]

3.1 Singleton pregnancy

8

3996

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.31, 1.19]

3.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.11, 4.00]

3.3 Singleton plus multiple pregnancy, or not stated

6

4512

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.35, 1.39]

4 Neonatal death Show forest plot

13

8167

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.53, 1.24]

4.1 Singleton pregnancy

7

2656

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.31, 1.53]

4.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.29, 3.46]

4.3 Singleton plus multiple pregnancies, or not stated

5

4459

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.48, 1.45]

5 Any potentially preventable perinatal death* Show forest plot

16

10225

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.46, 0.98]

5.1 Singleton pregnancy

9

4661

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.30, 1.13]

5.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.32, 2.41]

5.3 Singleton plus multiple pregnancies or not stated

6

4512

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.41, 1.15]

6 Apgar < 7 at 5 minutes Show forest plot

7

6321

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.69, 1.24]

6.1 Singleton pregnancy

4

2555

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.45, 1.09]

6.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Singleton plus multiple pregnancies or not stated

3

3766

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.77, 1.73]

7 Caesarean section (elective and emergency) Show forest plot

14

7918

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.84, 0.97]

7.1 Singleton pregnancy

7

2929

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.75, 0.95]

7.2 Multiple pregnancy

1

526

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.77, 1.19]

7.3 Singleton plus multiple pregnancies or not stated

6

4463

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.84, 1.05]

8 Caesarean section ‐ elective Show forest plot

11

6627

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.93, 1.22]

8.1 Singleton pregnancy

6

1934

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.90, 1.38]

8.2 Multiple pregnancy

1

526

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.77, 1.47]

8.3 Singleton plus multiple pregnancies or not stated

4

4167

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.84, 1.26]

9 Caesarean section ‐ emergency Show forest plot

10

6175

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.67, 0.98]

9.1 Singleton pregnancy

5

1482

Risk Ratio (M‐H, Random, 95% CI)

0.58 [0.43, 0.78]

9.2 Multiple pregnancy

1

526

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.57, 1.23]

9.3 Singleton plus multiple pregnancies or not stated

4

4167

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.77, 1.20]

10 Spontaneous vaginal birth Show forest plot

5

2504

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.98, 1.10]

10.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.96, 1.18]

10.2 Multiple pregnancy

1

526

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.90, 1.19]

10.3 Singleton plus multiple pregnancies or not stated

2

1402

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.95, 1.12]

11 Operative vaginal birth Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.80, 1.14]

11.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.78, 1.22]

11.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.68, 1.25]

12 Induction of labour Show forest plot

10

5633

Risk Ratio (M‐H, Random, 95% CI)

0.89 [0.80, 0.99]

12.1 Singleton pregnancy

5

1784

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.64, 0.97]

12.2 Multiple pregnancy

1

526

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.80, 1.50]

12.3 Singleton plus multiple pregnancies or not stated

4

3323

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.86, 1.04]

13 Infant requiring intubation/ventilation Show forest plot

6

3136

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.87, 2.30]

13.1 Singleton pregnancy

4

1539

Risk Ratio (M‐H, Random, 95% CI)

2.89 [1.40, 5.96]

13.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.59, 1.25]

13.3 Singleton plus multiple pregnancies or not stated

1

545

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.79, 1.98]

14 Neonatal fitting/seizures Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.49]

14.1 Singleton pregnancy

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.49]

14.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

15 Preterm labour Show forest plot

2

626

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.72, 1.75]

15.1 Singleton pregnancy

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.51, 2.07]

15.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.3 Singleton plus multiple pregnancy or not stated

1

476

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.66, 2.11]

16 Gestational age at birth (weeks) Show forest plot

8

4066

Mean Difference (IV, Random, 95% CI)

0.21 [‐0.02, 0.43]

16.1 Singleton pregnancy

3

1043

Mean Difference (IV, Random, 95% CI)

0.54 [‐0.00, 1.09]

16.2 Multiple pregnancy

1

1052

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.24, 0.44]

16.3 Singleton plus multiple pregnancies or not stated

4

1971

Mean Difference (IV, Random, 95% CI)

0.06 [‐0.19, 0.31]

17 Infant respiratory distress syndrome (RDS) Show forest plot

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.07, 16.48]

17.1 Singleton pregnancy

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.07, 16.48]

17.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Neonatal admission to SCBU and/or NICU Show forest plot

12

9334

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.89, 1.03]

18.1 Singleton pregnancy

8

4511

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.80, 1.06]

18.2 Multiple pregnancy

1

1052

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.88, 1.05]

18.3 Singleton plus multiple pregnancies or not stated

3

3771

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.85, 1.14]

19 Hypoxic ischaemic encephalopathy Show forest plot

2

1045

Risk Ratio (M‐H, Random, 95% CI)

0.65 [0.01, 33.07]

19.1 Singleton pregnancy

1

500

Risk Ratio (M‐H, Random, 95% CI)

0.09 [0.01, 1.64]

19.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19.3 Singleton plus multiple pregnancies or not stated

1

545

Risk Ratio (M‐H, Random, 95% CI)

4.91 [0.24, 101.79]

20 Intraventricular haemorrhage Show forest plot

4

2008

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [0.47, 4.30]

20.1 Singleton pregnancy

3

1463

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.38, 4.16]

20.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.3 Singleton plus multiple pregnancies or not stated

1

545

Risk Ratio (M‐H, Fixed, 95% CI)

2.95 [0.12, 71.99]

21 Birthweight (grams) Show forest plot

7

3887

Mean Difference (IV, Fixed, 95% CI)

31.33 [‐8.70, 71.37]

21.1 Singleton pregnancy

3

1916

Mean Difference (IV, Fixed, 95% CI)

49.34 [‐0.62, 99.31]

21.2 Multiple pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

21.3 Singleton plus multiple pregnancies or not stated

4

1971

Mean Difference (IV, Fixed, 95% CI)

‐0.95 [‐67.84, 65.95]

22 Length of infant hospital stay (days) Show forest plot

3

1076

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐0.40, ‐0.16]

22.1 Singleton pregnancy

3

1076

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.28 [‐0.40, ‐0.16]

22.2 Multiple pregnancy

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

22.3 Singleton plus multiple pregnancies or not stated

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

23 Birth < 34 weeks (not prespecified) Show forest plot

2

976

Risk Ratio (M‐H, Random, 95% CI)

2.04 [0.62, 6.69]

23.1 Singleton pregnancy

1

500

Risk Ratio (M‐H, Random, 95% CI)

1.17 [0.40, 3.42]

23.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.3 Singleton plus multiple pregnancies or not stated

1

476

Risk Ratio (M‐H, Random, 95% CI)

3.90 [1.11, 13.65]

24 Antenatal admissions (not prespecified) Show forest plot

2

893

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.60, 0.88]

24.1 Singleton pregnancy

2

893

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.60, 0.88]

24.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

24.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

25 Phototherapy for neonatal jaundice (not prespecified) Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.87]

25.1 Singleton pregnancy

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.87]

25.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

25.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

26 Abnormal neurological development at 9 months (not prespecified) Show forest plot

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.26, 1.45]

26.1 Singleton pregnancy

1

137

Risk Ratio (M‐H, Fixed, 95% CI)

0.61 [0.26, 1.45]

26.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

26.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

27 Hospitalisation for IUGR neonatal (not prespecified) Show forest plot

1

142

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.75, 1.41]

27.1 Singleton pregnancy

1

142

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.75, 1.41]

27.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

27.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28 Fetal distress in labour (not prespecified) Show forest plot

1

289

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.10, 1.22]

28.1 Singleton pregnancy

1

289

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.10, 1.22]

28.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

29 Birthweight < 5 percentile (not prespecified) Show forest plot

1

289

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.51, 2.64]

29.1 Singleton pregnancy

1

289

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [0.51, 2.64]

29.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

29.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

30 Periventricular leucomalacia (not prespecified) Show forest plot

1

545

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.00]

30.1 Singleton pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

30.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

30.3 Singleton plus multiple pregnancies or not stated

1

545

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.00]

31 Antenatal hospital stay (days) (not prespecified) Show forest plot

1

426

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐2.39, 1.19]

31.1 Singleton pregnancy

1

426

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐2.39, 1.19]

31.2 Multiple pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

31.3 Singleton plus multiple pregnancies or not stated

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Umbilical artery Doppler ultrasound versus no Doppler ultrasound
Comparison 2. Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 SGA/IUGR

5

1292

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.38, 1.35]

1.2 Hypertension/pre‐eclampsia

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

3.57 [0.42, 30.73]

1.3 Diabetes

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.4 Prolonged pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.5 Previous pregnancy loss

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

0.26 [0.03, 2.17]

2 Serious neonatal morbidity Show forest plot

1

53

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 SGA/IUGR

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Hypertension/pre‐eclampsia

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Diabetes

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.4 Prolonged pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.5 Previous pregnancy loss

1

53

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Umbilical artery Doppler ultrasound versus no Doppler ultrasound (all subgroups)
Comparison 3. Umbilical artery Doppler ultrasound alone versus CTG alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.17, 1.15]

1.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.07, 1.68]

1.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.16, 1.73]

2 Stillbirth Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.14, 1.71]

2.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.05, 1.70]

2.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.15, 7.41]

3 Neonatal death Show forest plot

3

1473

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.16, 1.72]

3.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.15, 7.10]

3.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.07, 1.72]

4 Any potentially preventable perinatal death* Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.12, 1.18]

4.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.41 [0.08, 2.11]

4.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.07, 1.72]

5 Apgar < 7 at 5 minutes Show forest plot

3

2663

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.54, 1.37]

5.1 Singleton pregnancy

2

1766

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.49, 1.43]

5.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.36, 2.39]

6 Caesarean section (elective and emergency) Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.79, 1.01]

6.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.77, 1.02]

6.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.73, 1.14]

7 Caesarean section ‐ elective Show forest plot

3

1473

Risk Ratio (M‐H, Fixed, 95% CI)

1.53 [1.12, 2.09]

7.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.69 [1.07, 2.67]

7.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.91, 2.15]

8 Caesarean section ‐ emergency Show forest plot

3

1473

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.52, 0.84]

8.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.36, 0.83]

8.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.55, 0.98]

9 Spontaneous vaginal birth Show forest plot

2

1323

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.97, 1.15]

9.1 Singleton pregnancy

1

426

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.91, 1.19]

9.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.95, 1.19]

10 Operative vaginal birth Show forest plot

3

2663

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.81, 1.17]

10.1 Singleton pregnancy

2

1766

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.80, 1.27]

10.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.68, 1.25]

11 Induction of labour Show forest plot

2

576

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.32, 1.40]

11.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Random, 95% CI)

0.67 [0.32, 1.40]

11.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Infant requiring intubation/ventilation Show forest plot

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [0.26, 9.08]

12.1 Singleton pregnancy

2

576

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [0.26, 9.08]

12.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

12.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Neonatal fitting/seizures Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.49]

13.1 Singleton pregnancy

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.49]

13.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Gestational age at birth Show forest plot

3

1473

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.00, 0.47]

14.1 Singleton pregnancy

2

576

Mean Difference (IV, Fixed, 95% CI)

0.26 [‐0.06, 0.59]

14.2 Multiple pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.3 Singleton plus multiple pregnancies or not stated

1

897

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.15, 0.55]

15 Neonatal admission to SCBU and/or NICU Show forest plot

4

2813

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.73, 1.03]

15.1 Singleton pregnancy

3

1916

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.64, 0.99]

15.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

15.3 Singleton plus multiple pregnancies or not stated

1

897

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.73, 1.37]

16 Infant birthweight (grams) Show forest plot

4

2813

Mean Difference (IV, Fixed, 95% CI)

38.41 [‐6.14, 82.97]

16.1 Singleton pregnancy

3

1916

Mean Difference (IV, Fixed, 95% CI)

49.34 [‐0.62, 99.31]

16.2 Multiple pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16.3 Singleton plus multiple pregnancies or not stated

1

897

Mean Difference (IV, Fixed, 95% CI)

‐4.0 [‐102.42, 94.42]

17 Length of infant hospital stay (days) Show forest plot

2

576

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐0.41, ‐0.08]

17.1 Singleton pregnancy

2

576

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐0.41, ‐0.08]

17.2 Multiple pregnancy

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.3 Singleton plus multiple pregnancies or not stated

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Antenatal admissions (not prespecified) Show forest plot

1

426

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.55, 0.90]

18.1 Singleton pregnancy

1

426

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.55, 0.90]

18.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

19 Phototherapy for neonatal jaundice (not prespecified) Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.87]

19.1 Singleton pregnancy

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 2.87]

19.2 Multiple pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

19.3 Singleton plus multiple pregnancies or not stated

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Antenatal hospital stay (days) (not prespecified) Show forest plot

1

426

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐2.39, 1.19]

20.1 Singleton pregnancy

1

426

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐2.39, 1.19]

20.2 Multiple pregnancy

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.3 Singleton plus multiple pregnancies or not stated

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Umbilical artery Doppler ultrasound alone versus CTG alone
Comparison 4. Umbilical artery Doppler ultrasound alone versus CTG alone (all subgroups)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 SGA/IUGR

2

572

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.05, 2.09]

1.2 Hypertension/pre‐eclampsia

1

89

Risk Ratio (M‐H, Fixed, 95% CI)

3.57 [0.42, 30.73]

1.3 Diabetes

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.4 Prolonged pregnancy

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.5 Previous pregnancy loss

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Umbilical artery Doppler ultrasound alone versus CTG alone (all subgroups)
Comparison 5. Early ductus venosus Doppler ultrasound versus CTG

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.39, 1.82]

1.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.39, 1.82]

2 Survival following severe neonatal morbidity Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.75, 1.61]

3 Stillbirth Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [0.37, 10.71]

3.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.99 [0.37, 10.71]

4 Neonatal death Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.22, 1.60]

4.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.22, 1.60]

5 Any potentially preventable perinatal death* Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.37, 1.86]

5.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.37, 1.86]

6 Fetal acidosis Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.20]

6.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.25 [0.03, 2.20]

7 Apgar < 7 at 5 minutes Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.44, 1.72]

7.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.44, 1.72]

8 Infant requiring intubation/ventilation Show forest plot

1

333

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.67, 1.13]

8.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.67, 1.13]

9 Intraventricular haemorrhage Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

8.95 [0.49, 164.87]

9.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

8.95 [0.49, 164.87]

10 Bronchopulmonary dysplasia Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.55, 1.38]

10.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.55, 1.38]

11 Necrotising enterocolitis Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.15]

11.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.03, 3.15]

12 Infant birthweight (grams) Show forest plot

1

333

Mean Difference (IV, Fixed, 95% CI)

38.0 [‐31.53, 107.53]

12.1 Singleton pregnancy

1

333

Mean Difference (IV, Fixed, 95% CI)

38.0 [‐31.53, 107.53]

13 Long‐term infant neurodevelopmental outcome (impairment at 2 years) Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.30, 1.18]

13.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.30, 1.18]

14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years) Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.68]

14.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.20 [0.02, 1.68]

15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified) Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.92, 1.23]

15.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.92, 1.23]

16 Sepsis (proven) (not prespecified) Show forest plot

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.60, 1.45]

16.1 Singleton pregnancy

1

333

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.60, 1.45]

Figures and Tables -
Comparison 5. Early ductus venosus Doppler ultrasound versus CTG
Comparison 6. Late ductus venosus Doppler ultrasound versus CTG

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.64, 2.55]

1.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.64, 2.55]

2 Survival following severe neonatal morbidity Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.66, 1.45]

3 Stillbirth Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

2.93 [0.60, 14.31]

3.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

2.93 [0.60, 14.31]

4 Neonatal death Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.47, 2.46]

4.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.47, 2.46]

5 Any potentially preventable perinatal death* Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.59, 2.53]

5.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.59, 2.53]

6 Fetal acidosis Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 2.00]

6.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 2.00]

7 Apgar < 7 at 5 minutes Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.69, 2.37]

7.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.69, 2.37]

8 Infant requiring intubation/ventilation Show forest plot

1

336

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.73, 1.20]

8.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.73, 1.20]

9 Intraventricular haemorrhage Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

16.60 [0.97, 285.35]

9.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

16.60 [0.97, 285.35]

10 Bronchopulmonary dysplasia Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.61, 1.48]

10.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.61, 1.48]

11 Necrotising enterocolitis Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.20, 4.77]

11.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.20, 4.77]

12 Infant birthweight (grams) Show forest plot

1

336

Mean Difference (IV, Fixed, 95% CI)

25.0 [‐40.06, 90.06]

12.1 Singleton pregnancy

1

336

Mean Difference (IV, Fixed, 95% CI)

25.0 [‐40.06, 90.06]

13 Long‐term infant neurodevelopmental outcome (impairment at 2 years) Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.15, 0.79]

13.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.15, 0.79]

14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years) Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.00, 1.59]

14.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.09 [0.00, 1.59]

15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified) Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [1.02, 1.34]

15.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [1.02, 1.34]

16 Sepsis (proven) (not prespecified) Show forest plot

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.42, 1.11]

16.1 Singleton pregnancy

1

336

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.42, 1.11]

Figures and Tables -
Comparison 6. Late ductus venosus Doppler ultrasound versus CTG
Comparison 7. Early ductus venosus Doppler ultrasound versus late

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any perinatal death after randomisation Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.32, 1.36]

1.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.32, 1.36]

2 Survival following severe neonatal morbidity Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.77, 1.65]

3 Stillbirth Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.20, 2.36]

3.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.20, 2.36]

4 Neonatal death Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.21, 1.47]

4.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.21, 1.47]

5 Any potentially preventable perinatal death* Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.31, 1.47]

5.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.31, 1.47]

6 Fetal acidosis Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

3.05 [0.13, 74.43]

6.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

3.05 [0.13, 74.43]

7 Apgar < 7 at 5 minutes Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.36, 1.29]

7.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.36, 1.29]

8 Infant requiring intubation/ventilation Show forest plot

1

337

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.71, 1.21]

8.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.71, 1.21]

9 Intraventricular haemorrhage Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.16, 1.66]

9.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.51 [0.16, 1.66]

10 Bronchopulmonary dysplasia Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.58, 1.46]

10.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.58, 1.46]

11 Necrotising enterocolitis Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.04, 3.23]

11.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.04, 3.23]

12 Infant birthweight (grams) Show forest plot

1

337

Mean Difference (IV, Fixed, 95% CI)

13.0 [‐59.31, 85.31]

12.1 Singleton pregnancy

1

337

Mean Difference (IV, Fixed, 95% CI)

13.0 [‐59.31, 85.31]

13 Long‐term infant neurodevelopmental outcome (impairment at 2 years) Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

1.75 [0.70, 4.32]

13.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

1.75 [0.70, 4.32]

14 Long‐term infant neurodevelopmental outcome (cerebral palsy at 2 years) Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

3.05 [0.13, 74.43]

14.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

3.05 [0.13, 74.43]

15 Infant survival at 2 years without neurodevelopmental impairment (not prespecified) Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.80, 1.03]

15.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.80, 1.03]

16 Sepsis (proven) (not prespecified) Show forest plot

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.84, 2.25]

16.1 Singleton pregnancy

1

337

Risk Ratio (M‐H, Fixed, 95% CI)

1.37 [0.84, 2.25]

Figures and Tables -
Comparison 7. Early ductus venosus Doppler ultrasound versus late