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Biomedical subjects

K Marsál

Publications and source records attributed to K Marsál.

At least 19 recordsLinked to original sources
PubMed2006

Gene expression profiling of human placentas from preeclamptic and normotensive pregnancies.

The aim of this study was to investigate patterns of gene expression in placental samples from patients with preeclampsia (PE), persistent bilateral uterine artery notching (without PE), and normal controls. This study included placental tissue from nine women with PE, seven with uncomplicated pregnancies and five with bilateral uterine artery notching in Doppler velocimetry tracings. Human cDNA microarrays with 6500 transcripts/genes were used and the results verified with real-time PCR and in-situ hybridization. Multidimensional scaling method and random permutation technique demonstrated significant differences among the three groups examined. Within the 6.5K arrays, 6198 elements were unique cDNA clones representing 5952 unique UniGenes and 5695 unique LocusLinks. Multidimensional scaling plots showed 5000 genes that met our quality criteria; among these, 366 genes were significantly different in at least one comparison. Differences in three genes of interest were confirmed with real-time PCR and in-situ hybridization; acid phosphatase 5 was shown to be overexpressed in PE samples and calmodulin 2 and v-rel reticuloendotheliosis viral oncogene homolog A (RELA) were downregulated in PE and uterine artery notch placentas. In conclusion downregulation of RELA and calmodulin 2 might represent an attempt by the placenta to compensate for elevations in intracellular calcium, possibly caused by hypoxia and/or apoptosis, in both pregnancies with uterine artery notching and preeclampsia.

Adult↗
PubMed2006

Sonographic investigation of the rectoanal inhibitory reflex: a qualitative pilot study in healthy females.

PURPOSE: The rectoanal inhibitory reflex has been studied using various methods, e.g., anometry and electromyography. The aim of this study was to apply ultrasound for direct visualization of the rectoanal inhibitory reflex. METHOD: The rectoanal inhibitory reflex was induced in ten healthy females (age range, 21-55 years) by injection of small amounts of water (7, 12, and 20 ml), into the rectum. The intra-anal pressure was measured with a microtransducer and the rectoanal inhibitory reflex was visualized with real-time transvaginal or transperineal sonography. RESULTS: The rectoanal inhibitory reflex consisted of a reduction in the intra-anal pressure and relaxation of the internal anal sphincter, manifested as an increase in the inner diameter of the internal anal sphincter from the mean of 11 to 16 mm (P<0.001). Simultaneously, a wave of rectal contents entered the anal canal. The distance from the most distal border of the rectal contents to the anal verge decreased from a mean of 33 to 20 mm (P<0.001). The rectoanal inhibitory reflex ended with a retrograde transport returning anal contents into the rectum. During the retrograde transport a contraction in the internal anal sphincter was observed. CONCLUSIONS: The rectoanal inhibitory reflex can readily be visualized with ultrasound as a wave of rectal contents entering the anal canal. The transport into the anal canal was not of voluntary origin and could be either noticed or not noticed by the subjects. The observed retrograde transportation in the anal canal was not noted by the subjects; it is related to a contraction in the internal anal sphincter and visualized for the first time using ultrasound.

Adult↗
PubMed2005

Impaired vascular growth in late adolescence after intrauterine growth restriction.

BACKGROUND: Abnormal blood flow in a fetus small for gestational age indicates true fetal intrauterine growth restriction (IUGR). We tested the hypothesis that IUGR with abnormal fetal blood flow is associated with long-term abnormal vascular morphology and function in adolescence. METHODS AND RESULTS: In a prospective study, vascular mechanical properties of the common carotid artery (CCA), abdominal aorta, and popliteal artery (PA) were assessed by echo-tracking sonography in 21 adolescents with IUGR and abnormal fetal aortic blood flow and in 23 adolescents with normal fetal growth and normal fetal aortic blood flow. Endothelium-dependent and -independent vasodilatation of the brachial artery was measured by high-resolution ultrasound. After adjustment for body surface area and sex, the IUGR group had significantly smaller end-diastolic vessel diameters than the referents in the abdominal aorta and PA (mean difference, 1.7 mm [95% CI, 0.62 to 2.74] and 0.6 mm [95% CI, 0.25 to 1.02], respectively) (P=0.003 and P=0.002, respectively), with a similar trend in the CCA (P=0.09). A higher resting heart rate was observed in the IUGR group (P=0.01). No differences were found in stiffness or in endothelium-dependent and -independent vasodilatation between the 2 groups. CONCLUSIONS: IUGR caused by placental insufficiency appears to be associated with impaired vascular growth persisting into young adulthood in both men and women. The smaller aortic dimensions and the higher resting heart rate seen in adolescents with previous IUGR may be of importance for future cardiovascular health.

Adolescent↗
PubMed2005

Implementation of new medical techniques: experience from the Swedish randomized controlled trial on fetal ECG during labor.

BACKGROUND: In a large Swedish multicenter randomized controlled trial (RCT) on intra partum fetal monitoring with automatic analysis of fetal ECG waveform (STAN) in combination with cardiotocography (CTG) (4966 parturients, 300 obstetricians and midwives managing the patients), interim analysis revealed protocol violations. By a post hoc analysis of the results over time, factors affecting the acceptance of the new technique were analyzed. METHODS: The rates of primary and secondary outcome measures (fetal outcome, operative deliveries) were compared in the two study groups (CTG + ST and CTG only). Changes over time were statistically evaluated using a test for homogeneity between the two periods. RESULTS: After retraining, the CTG + ST group showed the lowest rates of operative delivery for fetal distress, fetal blood sampling and admissions to neonatal intensive care unit. Operative deliveries (p = 0.02) and the number of fetal blood sampling decreased significantly over time (p = 0.001). CONCLUSIONS: Training and education probably predisposed the clinicians to a change and reinforced it when it occurred as a result of increased personal experience. The audit and feedback together with the influence of opinion leaders and inter-collegial interactions seem to have been of importance for the successively increasing acceptance of the new method during the RCT.

Cardiotocography↗
PubMed2004

Validation of fractional moving blood volume measurement with power Doppler ultrasound in an experimental sheep model.

OBJECTIVE: To compare fractional moving blood volume (FMBV) estimation using power Doppler ultrasound (PDU) with blood flow estimation using radioactive microspheres (RMS) for evaluation of fetal organ blood perfusion. METHODS: Blood flow was measured in the adrenal gland of nine exteriorized fetal lambs. Five fetal lambs underwent total umbilical cord occlusion in order to induce changes in the adrenal blood flow (asphyxia group). Four lambs were used as sham controls (control group). Three RMS injections, with coincident PDU recordings of the adrenal gland, were performed in each lamb. In the asphyxia group, measurements were taken before the cord occlusion, 5 min later and when the mean blood pressure decreased below 25 mmHg. In the control group, the measurements were done with an interval of 5 min. FMBV normalized for attenuation of PDU signals, and mean pixel intensity (MPI) were estimated offline. After completion of the study, adrenal blood perfusion was calculated according to the reference sample microsphere technique, using the isotope activity and expressed in mL/min/100 g. The correlation between RMS and FMBV and MPI, respectively, was analyzed individually for each lamb. RESULTS: In the asphyxia group, all lambs showed a marked reduction in the adrenal blood perfusion towards the third RMS injection. In the control group, the adrenal perfusion showed small variations throughout the experiment. In the total material, there was a higher correlation between FMBV and RMS (median, r = 0.90; range, 0.43-0.99) than between MPI and RMS (median, r = 0.55; range, -0.53 to 0.99). CONCLUSION: The FMBV method of quantifying PDU signals correlates highly with blood flow perfusion estimation using RMS in the fetal lamb adrenal gland.

Adrenal Glands↗
PubMed2004

Fractional moving blood volume estimation in the fetal lung using power Doppler ultrasound: a reproducibility study.

OBJECTIVE: To evaluate the reproducibility of fractional moving blood volume (FMBV) estimation in the fetal lung using power Doppler ultrasound (PDU). METHODS: The lung blood perfusion of 20 normally grown singleton fetuses at 32-35 weeks of gestation was evaluated by two experienced observers using PDU. Each observer recorded two consecutive sequences of images from the posterior part of the fetal lung and calculated FMBV offline. FMBV expresses the percentage of blood movement within a defined region of interest (ROI). Repeatability and agreement were evaluated by means of the intraclass (intraCC) and interclass (interCC) correlation coefficients. RESULTS: FMBV was successfully evaluated in 17/20 fetuses by both observers (kappa index 0.82; 95% CI 0.51-0.93). The intraCC for repeatability for Observer A was 0.92 (95% CI 0.78-0.96), and for Observer B 0.90 (95% CI 0.74-0.96). The mean difference between the first and the second measurement was 0.7% (SD 4.5%). The interCC for repeatability over time and between the operators was 0.70 (95% CI 0.56-0.76) and the mean difference between the observers was 0.6% (SD 4.65%). The interCC for agreement was 0.92 (95% CI 0.84-0.95) and the mean difference in FMBV results when both observers analyzed the same sequences offline was 0.6% (SD 3.85%). CONCLUSION: In the hands of experienced operators, using a well-defined ROI and standard settings, FMBV estimation is a reproducible method of quantifying power Doppler signals recorded from fetal lung blood perfusion.

Blood Flow Velocity↗
PubMed2004

Norepinephrine transporter (NET), serotonin transporter (SERT), vesicular monoamine transporter (VMAT2) and organic cation transporters (OCT1, 2 and EMT) in human placenta from pre-eclamptic and normotensive pregnancies.

Pre-eclampsia is one of the most common causes of perinatal and maternal morbidity and mortality. High blood pressure and proteinuria are important clinical signs of pre-eclampsia. Sympathetic overactivity and elevated level of circulating vaso active substances, such as monoamines has been shown. Extracellular concentrations of monoamines are normally kept low by specific transporter proteins of which many are expressed in the placenta. In this study we used in situ hybridization and real-time PCR to study the gene expression of monoamine transporters, such as NET, SERT, VMAT2, EMT and OCT1/2, in normal as well as in pre-eclamptic placentae. We demonstrated high expression of NET mRNA in the trophoblast cells of the anchoring villi and a lower expression intensity in the chorionic villi. SERT mRNA was mainly detected in chorionic villi. VMAT2 mRNA was not detected in the central part of the placenta but was present in the spiral arteries of placenta bed biopsies, in cytokeratin positive cells. EMT mRNA was mainly detected in the intra lobular septa and together with OCT1 and OCT2 mRNAs also expressed in scattered cells of placental vessel adventitias. Moreover, quantitative analysis showed a significant lower expression of NET and EMT mRNAs in pre-eclamptic placentae as compared to the control group. A defective gene expression or function of these monoamines transporters might explain the elevated concentrations of monoamines in pre-eclamptic patients. Monoamine transporters may serve as a protective mechanism preventing vasoconstriction in the placental vascular bed and thereby securing a stable blood flow to the fetus.

Adult↗
PubMed2004

Abnormal mechanical properties of larger arteries in postmenopausal women with systemic lupus erythematosus.

There is limited knowledge of potential defects in arterial wall properties in female systemic lupus erythematosus (SLE) patients without manifest cardiovascular disease (CVD) and significant atherosclerotic lesions. The aim of the present study was to investigate the mechanical properties of larger vessels in these patients and to compare them with healthy controls. B-mode ultrasound was used to assess vessel wall structure and to exclude presence of plaque. The ankle/brachial pressure index was measured to exclude occlusive arterial disease. An ultrasound echo-tracking system was used to determine stiffness of the abdominal aorta, common carotid artery (CCA) and popliteal artery (PA) in 39 female patients with SLE and 55 female, healthy controls. SLE had an independent effect on stiffening of the CCA (P = 0.01) and PA (P = 0.005). In addition, larger vessel diameters were observed in the CCA (P = 0.002) after adjustments for the effects of mean arterial pressure and age. Thus, this investigation demonstrated an increased arterial stiffness and signs of premature vascular ageing in the SLE patients without manifest cardiovascular disease and without significant atherosclerotic lesions. The results of this study indicate that other mechanisms besides atherosclerosis might be involved in the pathogenesis of arterial stiffening in SLE patients.

Age Factors↗
PubMed2003

Skewed fetal gender distribution in prolonged pregnancy: a fallacy with consequences.

OBJECTIVE: Skewed gender distribution and falsely assigned gestational age lead to unnecessary or late obstetric intervention in prolonged pregnancy. The aim of this study was to examine the consequences of a fetal gender-dependent systematic 1.5-day dating error at ultrasound fetometry. MATERIAL AND METHODS: A total of 82 484 singleton deliveries >/=37 weeks at 11 hospitals in southern Sweden from 1995 to 2000 were included. Frequencies of labor induction and Apgar scores <7 at 5 min were compared with regard to fetal gender, both before and after correction of gestational age by adding 0.75 days to female-fetus pregnancies and subtracting 0.75 days from male-fetus pregnancies. RESULTS: The uncorrected odds ratio for having a male baby at >/=42 weeks was 1.41 (95% confidence interval, 1.33-1.49). After adjusting gestational age by +/-0.75 days, the odds ratio reduced to 0.90 (95% confidence interval, 0.84-0.95). The risk for labor induction was significantly above unity in male-fetus pregnancies delivered after 41 weeks when gestational age was corrected for fetal gender, while the risk for female fetuses having a low Apgar score was not significantly increased compared to male fetuses (P = 0.087). CONCLUSION: Skewed gender distribution in prolonged pregnancy results in a higher rate of labor induction in pregnancies with male fetuses at >/=41 weeks, and the risk for newborn females having a low Apgar score in prolonged pregnancy is not significantly increased compared to boys.

Diagnostic Errors↗
PubMed2002

Can the degree of retrograde diastolic flow in abnormal umbilical artery flow velocity waveforms predict pregnancy outcome?

OBJECTIVE: Reverse end-diastolic flow is the most pathological type of the umbilical artery flow velocity waveform. We aimed to investigate whether additional prognostic information can be obtained from umbilical artery waveforms in cases with reverse end-diastolic flow. SUBJECTS AND METHODS: Umbilical artery Doppler velocity waveforms from 44 fetuses with reverse end-diastolic flow were analyzed and the following parameters measured: the highest amplitude and the area below the maximum velocity curve of forward and reverse flow (A, B and C, D, respectively) and the duration of forward and reverse flow (Tc and Td, respectively). Ratios A/B, C/D and Tc/Td were calculated. The cut-off values for A/B, C/D and Tc/Td with the best predictive values for perinatal death were established with the help of receiver operating characteristics curves. The three curves were compared with each other. RESULTS: Of the three ratios, A/B and C/D had the best capacity to predict perinatal death. Both ratios had acceptable sensitivities, specificities and positive predictive values. In this regard, A/B and C/D were comparable. The cut-off values for A/B and C/D were 4.3 and 4.52, respectively. Survivors had I significantly higher A/B and C/D ratios than non-survivors (P = 0.0001 and 0.0003, respectively). Significantly more fetuses with A/B or C/D below the established cut-off values had pulsations in the venous system (P < 0.05). In fetuses with a gestational age < =210 gestational days the survival rate was significantly higher in those with A/B or C/D above the cut-off values (P = 0.03 and 0.003, respectively). CONCLUSIONS: The A/B or C/D ratio can be used for quantification of the reverse end-diastolic flow waveforms in the umbilical artery and may offer additional information to the evaluation of fetal condition.

Blood Flow Velocity↗
PubMed2002

Uterine artery score and perinatal outcome.

OBJECTIVE: To evaluate a modified uterine artery score based on the pulsatility index and presence or absence of notching in the Doppler velocity waveform recorded from both uterine arteries in relation to the perinatal outcome. METHODS: A retrospective analysis was performed in 741 third-trimester high-risk pregnancies. The uterine artery score was constructed assigning one point to each abnormal parameter-high pulsatility index and presence of notch-thus ranging from 0 (normal findings in both uterine arteries) to 4 (notch and high pulsatility index in both uterine arteries). In a subgroup with lateral placenta (n = 359), two definitions of abnormal pulsatility index were compared. In the uniform uterine artery score, a pulsatility index > 1.20 in both uterine arteries was considered abnormal, disregarding the placental location; in the subgroup with lateral placenta, the high pulsatility index was defined as > 1.00 on the placental side and > 1.40 on the non-placental side. RESULTS: Receiver-operating characteristic curves did not reveal any difference in the diagnostic capacity between the group with a uniform uterine artery score and the subgroup with lateral placenta (P = 0.54). In the total material, the odds ratios and linear regression analysis showed an increased risk for an adverse perinatal outcome with increasing uterine artery score (P < 0.01). At a uterine artery score > 2, there was a significantly increased risk for operative delivery for fetal distress, neonatal intensive care unit admission, 5-min Apgar score < 7, preterm delivery and delivery of a small-for-gestational age fetus. CONCLUSION: In high-risk third-trimester pregnancies, Doppler velocity waveforms of the uterine arteries can be evaluated using the uterine artery score disregarding the placental location. The uterine artery score possesses a high predictive value regarding adverse perinatal outcome.

Adult↗
PubMed2002

Altered vascular function in healthy normotensive pregnant women with bilateral uterine artery notches.

OBJECTIVES: To assess endothelial function and vascular mechanical properties in normotensive pregnant women with high resistance in the uteroplacental circulation. DESIGN: Cross-sectional prospective study. SETTING: Doppler ultrasound laboratory at university department of obstetrics and gynaecology referral centre for high risk pregnancies. PARTICIPANTS: Forty-two caucasian normotensive pregnant women: 23 with uncomplicated pregnancies and 19 with bilateral uterine artery notches. METHODS: Flow-mediated dilatation of the brachial artery was measured by ultrasonography at 25 gestational weeks. Concentrations of nitrite and nitrate in the plasma were established at 25 and 32 gestational weeks. The elastic properties of the common carotid artery, abdominal aorta and popliteal artery were measured with an ultrasonic echo-tracking system. RESULTS: Flow-mediated dilatation at two minutes after cuff deflation was significantly lower in the bilateral notch group compared with the control group, 8.3% and 13.7%, respectively (P = 0.0007). The ability to sustain vasodilatation was reduced in the bilateral notch group (P = 0.02). Lower values of nitrite and nitrate in the plasma were found at 32 gestational weeks in the bilateral notch group than in the control group (mean 24.76 microM/L (SD 5.6) and 30.93 microM/L (8.2), respectively; P = 0.008). Nitrite and nitrate levels tended to be lower in the bilateral notch group even at 25 gestational weeks (29.45 microM/L (8.3) and 35.73 microM/L (11.0) in the bilateral notch and control group, respectively; P = 0.09). There was no difference in aortic, carotid or popliteal elasticity between the two groups. CONCLUSIONS: Healthy normotensive pregnant women with bilateral uterine artery notches show impaired endothelial function, but no differences in vascular mechanical properties.

Arteries↗
PubMed2001

Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial.

BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.

Acidosis↗
PubMed2001

Brain-specific NSE and S-100 proteins in umbilical blood after normal delivery.

BACKGROUND: To determine normal blood levels of brain-specific proteins S-100 and neuron specific enolase (NSE) in healthy newborns and their mothers following uncomplicated birth. METHODS: Umbilical artery and vein blood and maternal venous blood was collected at 112 consecutive uncomplicated deliveries. Venous blood samples were taken from 18 of the neonates 3 days after birth. S-100 and NSE were analyzed quantitatively by double antibody immunoluminometric assay (Sangtec Medical AB, Sweden). RESULTS: Compared with adults, healthy neonates had higher levels of both S-100 and NSE. For S-100, median levels (range) were 1.10 microg/l (0.38-5.50 microg/l and 0.98 microg/l (0.43-2.70 microg/l) in umbilical artery and vein, respectively. For NSE, median levels (range) in umbilical artery blood and vein were 27 microg/l (10-140 microg/l) and 10.75 microg/l (8.80->/=200 microg/l) respectively. The maternal venous blood levels of both S-100 and NSE were significantly lower than in their infants. At 3 days of life, neonatal venous levels of the proteins were still high: S-100, 0.48-9.70 microg/l; NSE, 17->/=200 microg/l. In contrast to adults, haemolysis affected the S-100 levels in umbilical blood significantly. CONCLUSION: Concentrations of both S-100 and NSE in blood are greater in newborns after normal birth than in healthy adults. The higher levels in umbilical artery blood than in umbilical vein blood are consistent with a fetal origin of these proteins. High levels in venous blood at 3 days of life suggest that the high levels at birth are not related to the birth process but reflect a high activity of these proteins during fetal development.

Adult↗
PubMed2001

Ventriculo-vascular interaction in the normal development of the fetal circulation.

OBJECTIVES: To examine cardiovascular physiology in the healthy fetus during normal development. DESIGN: Twenty normal fetuses were studied longitudinally from 20 weeks to term. Serial echocardiography was performed, and arterial and venous diameter pulse wave characteristics and aortic pulse wave propagation velocity (PWV) were examined in the thoracic descending aorta (AoD) and inferior caval vein (IVC) using an ultrasonic phase-locked echo-tracking system. Statistical analyses included ANOVA, paired t-test and logistic regression where appropriate. RESULTS: Aortic PWV, maximum incremental and late decremental velocities increased with gestation while the relative pulse amplitude decreased, reflecting falling distal impedance. There was a linear increase in cardiac preload and relative pulse amplitude in the IVC with gestation that correlated significantly with the presence of end-diastolic flow in the pulmonary artery and improvement in right ventricular diastolic function. CONCLUSIONS: Non-invasive concurrent assessment of preload, ventricular function and impedance are possible in the fetus and may prove useful in the longitudinal study of fetal adaptation to pathophysiological changes.

Aorta, Thoracic↗
PubMed2001

A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics.

OBJECTIVES: To reanalyze randomized controlled trials on the use of umbilical artery Doppler velocimetry in high-risk pregnancies and determine which high-risk pregnancies benefit from the use of Doppler velocimetry. METHODS: Searching Medline, the Cochrane Library and Embase we found 13 randomized controlled trials on the use of Doppler velocimetry in high-risk pregnancies. Of these, six included pregnancies with strictly defined suspected intrauterine growth restriction and/or hypertensive disease of pregnancy ('well-defined studies'); the rest included a great variety of high-risk pregnancies ('general risk studies'). The studies were analyzed with particular regard to the heterogeneity and to outcome. Audits of the perinatal deaths reported in the randomized controlled trials were performed by a panel of 32 international experts. RESULTS: The 'well-defined studies' had a more uniform study design as compared to the 'general risk studies' and they showed a significant reduction in antenatal admissions (odds ratio, 0.56; 95% confidence interval, 0.43-0.72), inductions of labor (0.78; 0.63-0.96), elective deliveries (inductions of labor and elective Cesarean sections) (0.73; 0.61-0.88) and Cesarean sections (0.78; 0.65-0.94). By perinatal audit it was found that more perinatal deaths in the 'well-defined studies' were potentially avoidable by use of Doppler velocimetry ( P < 0.0005) and the rate of avoidable perinatal deaths was higher among controls (50%) than cases (20%) in this group. CONCLUSION: The randomized controlled trials on umbilical artery Doppler velocimetry show major differences regarding study design and technical and clinical issues and, therefore, they should not be pooled in a simple meta-analysis. By stratification it was found that only in pregnancies with suspected intrauterine growth restriction and/or hypertensive disease of pregnancy will the use of umbilical artery Doppler velocimetry reduce the number of perinatal deaths and unnecessary obstetric interventions.

Confidence Intervals↗