Authors' objectives:

To assess the value of Doppler in the monitoring of pregnancy, at the request of the Caisse Nationale d'Assurance Maladie des Travailleurs Salaries (CNAMTS) (French salaried workers health insurance fund). Clinical study: to define the predictive value and beneficial effects on mother and child health. Economic study: to study market trends and industrial strategies and the correlation between the level of sophistication of equipment and the clinical indications.

Authors' results and conclusions: Doppler (continuous emission, pulsed emission, colour) studies of uterine arteries evaluate uteroplacental resistance, reflecting the maternal component of the materno-placento-foetal unit. Increased resistance, reflecting placental vascular disease can lead to pregnancy-induced hypertension, pre-eclampsia, fetal distress and intrauterine growth retardation (IUGR). Doppler is also used to study the umbilical artery, fetal cerebral arteries, umbilical vein and aorta. Doppler is noninvasive and predictive of IUGR and pre-eclampsia by the 2nd trimester, but no effective preventive measure is available unless the efficacy of aspirin can be demonstrated.

Authors' recommendations: Uterine Doppler should not be performed in the general population due to the absence of any effective preventive measure. Two large-scale French multicenter studies are underway to evaluate the efficacy of aspirin in the case of pathological uterine Doppler in a population of primiparous women. Umbilical artery Doppler is predictive of IUGR and a poor perinatal prognosis, requiring reinforced monitoring, possible admission of the mother and extraction of the infant in the case of fetal distress. In a high-risk population, umbilical artery Doppler can reduce perinatal mortality by 50%, but it is not indicated in the general population. Identification of certain centers with high technology equipment would allow management of the more complex clinical cases. As for ultrasound, the quality of the examination depends on good maintenance and quality control. Other output or dissemination activity: Currently in France, only high risk women are reimbursed for the Doppler.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: Agence Nationale pour le Developpement de l'Evaluation Medicale