Umbilical artery resistance index as a screening test for fetal well-being. II: Randomized feasibility study

To determine whether the time taken for fetal assessment could safely be reduced by preliminary screening with Doppler ultrasound, 897 women having fetal assessment in the high-risk unit of the John Radcliffe Hospital, Oxford, were randomly allocated to two groups. In the Doppler group, preliminary assessment was by umbilical artery resistance estimation, and in the fetal heart rate (FHR) group by computerized FHR analysis. To minimize the risk of failing to recognize fetal distress, the criteria for using the nonallocated method as well were deliberately conservative. Thus, 66% of the 1869 Doppler studies done in the Doppler group and 39% of the 2069 FHR tests done in the FHR group needed to be followed by the nonallocated tests. Trained nursing staff performed the Doppler studies as part of their routine duties. Doppler studies were unsuccessful in obtaining a result on 26% of the occasions. Under the above clinical circumstances, preliminary Doppler screening did not reduce the time taken for fetal assessment. There were no significant differences in perinatal outcome between the groups, except that emergency as opposed to elective cesareans were less frequent in the Doppler group. As this finding was not predicted by previous hypothesis, it needs to be confirmed.