The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed:
Unterscheider J, Daly S, Geary MP, et al. Predictable progressive Doppler deterioration in IUGR—does it really exist? Am J Obstet Gynecol 2013;209:539.e1-7.
See related article, page 539
- ■
Why is this research question interesting?
- ■
What was the study design?
- ■
Were the scans standardized in any way?
- ■
What were the results?
- ■
What were the study’s strengths?
- ■
Will the findings change your practice at all?
Five-point assessment
Unterscheider et al designed the PORTO study, which enrolled 1200 women carrying a fetus with IUGR. Doppler measures—umbilical artery, middle cerebral artery (MCA), ductus venosus, aortic isthmus, and myocardial performance index—were performed at a minimum of every 2 weeks until delivery, along with evaluation of amniotic fluid volume and biophysical profile scoring. The information from the Doppler results was made available to the treating physicians.
After examining the data, the investigators found that the progression of blood vessel deterioration, as documented by Doppler ultrasound, varies among patients, and no predominant pattern was evident. In addition, the single best predictor of adverse neonatal outcomes was an abnormal UA Doppler image. It captured 86% of all noted adverse outcomes. An abnormal MCA Doppler image was the next most useful test, detecting 51% of adverse outcomes. The investigators stated that using significant time and effort to seek other Doppler abnormalities would likely detect a “relatively small proportion” of additional adverse outcomes.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
