Antenatal Doppler screening for fetuses at risk of adverse outcomes: a multicountry cohort study of the prevalence of abnormal resistance index in low-risk pregnant women
Joshua P Vogel,
Olufemi T Oladapo,
Ernest Maya,
Richard Adanu,
Zahida P Qureshi,
George Gwako,
Alfred Osoti,
Shivaprasad S Goudar,
Robert C Pattinson,
Tanita Botha,
Valerie Vannevel,
Umesh Charantimath,
Avinash Kavi,
Yeshita Pujar,
Stephen Rulisa
Affiliations
Joshua P Vogel
International Development, Burnet Institute, Melbourne, Victoria, Australia
Olufemi T Oladapo
45 UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
Ernest Maya
Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
Richard Adanu
School of Public Health, University of Ghana, Legon, Ghana
Zahida P Qureshi
40 University of Nairobi Department of Obstetrics and Gynecology, Nairobi, Kenya
George Gwako
Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
Alfred Osoti
Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
Shivaprasad S Goudar
Women`s and Children`s Health Research Unit, KLE Academy of Higher Education and Research`s, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
Robert C Pattinson
Maternal and Infant Health Care Strategies Unit, SAMRC, Pretoria, South Africa
Tanita Botha
Department of Statistics, University of Pretoria, Pretoria, South Africa
Valerie Vannevel
Maternal and Infant Health Care Strategies Unit, SAMRC, Pretoria, South Africa
Umesh Charantimath
Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
Avinash Kavi
Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
Yeshita Pujar
Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
Stephen Rulisa
Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), University of Rwanda, Kigali, Rwanda
Introduction Few interventions exist to address the high burden of stillbirths in apparently healthy pregnant women in low- and middle-income countries (LMICs). To establish whether a trial on the impact of routine Doppler screening in a low-risk obstetric population is warranted, we determined the prevalence of abnormal fetal umbilical artery resistance indices among low-risk pregnant women using a low-cost Doppler device in five LMICs.Methods We conducted a multicentre, prospective cohort study in Ghana, India, Kenya, Rwanda and South Africa. Trained nurses or midwives performed a single, continuous-wave Doppler screening using the Umbiflow device for low-risk pregnant women (according to local guidelines) between 28 and 34 weeks’ gestation. We assessed the prevalence of abnormal (raised) resistance index (RI), including absent end diastolic flow (AEDF), and compared pregnancy and health service utilisation outcomes between women with abnormal RI versus those with normal RI.Results Of 7151 women screened, 495 (6.9%) had an abnormal RI, including 14 (0.2%) with AEDF. Caesarean section (40.8% vs 28.1%), labour induction (20.5% vs 9.0%) and low birth weight (<2500 g) (15.0% vs 6.8%) were significantly more frequent among women with abnormal RI compared with women with normal RI. Abnormal RI was associated with lower birth weights across all weight centiles. Stillbirth and perinatal mortality rates were similar between women with normal and abnormal RI.Conclusion A single Doppler screening of low-risk pregnant women in LMICs using the Umbiflow device can detect a large number of fetuses at risk of growth restriction and consequent adverse perinatal outcomes. Many perinatal deaths could potentially be averted with appropriate intervention strategies.Trial registration number CTRI/2018/07/01486.
