***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: We have done a r and omised controlled trial to assess the effect on primary management and outcome of routine doppler ultrasound examinations of the umbilical and uterine arteries during pregnancy . Over 9 months , 2600 women with singleton pregnancies were recruited from a general obstetric population . Of 2475 women who delivered in hospital after 20 weeks ' gestation , 1246 had been allocated at r and om to receive st and ard antenatal care with routine doppler examinations . The first doppler ultrasound was done at 19 - 22 weeks ' gestation , and thereafter examinations were monthly if the pregnancy was considered high risk ( 192 ) or once at 32 weeks if considered low risk ( 1054 ) . The control group of 1229 women received  st and ard , antenatal care without doppler ultrasonography . The study groups did not differ in number of antenatal admissions or cardiotocographs , gestational age at delivery , method of delivery , frequency of deliveries with fetal distress , or need for resuscitation or admission to the neonatal intensive care unit . More perinatal deaths occurred in the doppler group ( 17 vs 7 , relative risk 2.4 , 95 % Cl 1.00 - 5.76 ) , but only 1 of 11 normally formed stillbirths and none of the 4 normally formed neonatal deaths after 24 weeks ' gestation had an abnormal umbilical-artery doppler examination . We did not demonstrate any improvement in neonatal outcome by routine doppler ultrasound screening of a general obstetric population Introduction The Colombian study was undertaken in Cali , the third largest city in the country with a population of about 1 500 000 . It has one of the best regionalized medical facilities in the country ; most of our data were obtained from the tertiary-level hospital , a referral centre for most of the perinatal problems that appear in the urban area . In a sample of 5038 mothers with recorded pre-pregnancy weight and height during 1989 , 1320 had information of weight gain during the pregnancy period . In addition to this sample from the high-risk hospital , a further sample from one of the six low-risk delivery hospitals was also studied for neonatal outcomes only - since by definition the later does not have maternal complications . A total of 527 mothers who had information on their pre-pregnancy weight and height during the year 1989 were chosen from this low-risk delivery group . It is worth noting that neither the mother 's weight nor height appears as a risk indicator on the clinical record proposed by CLAP ( Centro Latino ( Americano de Perinatologia y Desarrollo Humana ) ( 1 ) and routinely used in these hospitals ; this can result in mothers with a low pre-pregnant weight and low height appearing in either the high-risk or low-risk delivery hospitals . Study objectives . The main objectives of the study were to investigate associations between maternal anthropometry ( height , pre-pregnancy weight , and weight gain during pregnancy ) , and the presence of perinatal complications in the mother or neonate . Several categories of infant outcome were considered : full-term LBW infants ( FT-LBW ) , all LBW infants , and pre-term deliveries , to see if it was possible to establish cut-off points for the anthropometric parameters in order to use them as risk indicators of the perinatal outcome . Methodology Since 1986 a number of workshops were held in all the hospitals in Cali to teach nurses and doctors to fill out the CLAP medical record in the follow-up of pregnant women and their newborns . For this study all medical records at the tertiary-level hospital were search ed for the data on pre-pregnancy weight and mother 's height .  Of the 10 332 women attending , 5038 had the relevant information and these were selected for the study . In the low-risk delivery hospital , 527 out of 1976 deliveries in 1989 met the criteria for entry into the study . Length of pregnancy was determined by the date of LMP and by the Dubowitz score and if these disagreed by more than 2 weeks , the case was dropped from the study . Pre-pregnancy weight was based on patient recall . The definitions of study variables used here were the same as reported in the meta- analysis . Results and discussion Maternal anthropometry is an indicator of risk for pregnancy complications and neonatal problems when it is associated with other perinatal risk factors . Anthropometric data alone are not per se good risk indicators according to our findings . This hypothesis is very important from the public health point of view and will need to be further confirmed or rejected by prospect i ve studies undertaken in communities where both high- and low-risk deliveries can be compared for maternal and newborn outcomes . As far as we know , no such study has been undertaken in developing countries where perinatal risk is high , especially in relation to IUGR . The percentage of mothers found to be of low pre-pregnancy weight ( WTpp )  was similar in the low-risk hospital ( Background Delayed maternal reporting of decreased fetal movement ( DFM ) is associated with adverse pregnancy outcomes . Inconsistent information on fetal activity to women during the antenatal period may result in delayed reporting of DFM . We aim ed to evaluate an intervention of implementation of uniform information on fetal activity to women during the antenatal period . Methods In a prospect i ve before- and -after study , singleton women presenting DFM in the third trimester across 14 hospitals in Norway were registered . Outcome measures were maternal behavior regarding reporting of DFM , concerns and stillbirth . In addition , cross-sectional studies of all women giving birth were undertaken to assess maternal concerns about fetal activity , and population -based data were obtained from the Medical Birth Registry Norway . Results Pre- and post-intervention cohorts included 19 407 and 46 143 births with 1 215 and 3 038 women with DFM respectively . Among primiparous women with DFM , a reduction in delayed reporting of DFM ( ≥48 hrs ) OR 0.61 ( 95 % CI 0.47 - 0.81 ) and stillbirths OR 0.36 ( 95 % CI 0.19 - 0.69 ) was shown in the post-intervention period . No difference was shown in rates of consultations for DFM or maternal concerns . Stillbirth rates and maternal behavior among women who were of non-Western origin , smokers , overweight or > 34 years old were unchanged . Conclusions Uniform information on fetal activity provided to pregnant women was associated with a reduction in the number of primiparous women who delayed reporting of DFM and a reduction of the stillbirth rates for primiparous women reporting DFM . The information did not appear to increase maternal concerns or rate of consultation . Due to different imperfections in different clinical setting s , further studies in other population s replicating these findings are required OBJECTIVE To evaluate the effect on management and outcome of pregnancy of routine umbilical Doppler examination in low risk population s. DESIGN Pragmatic r and omised controlled trial . SETTING Twenty centres caring for low risk pregnant women . PARTICIPANTS 4187 women were r and omly assigned to umbilical Doppler between 28 and 34 weeks of gestation or no routine umbilical Doppler . The women included were at low risk at 28 weeks of gestation defined by a normal ultrasonographic examination at the time of r and omisation and no obstetric or medical complications during the first two trimesters of the pregnancy . RESULTS The general characteristics at inclusion were comparable for the two groups . Performance of umbilical Doppler led to a significant increase in the number of ultrasonographic and Doppler examinations subsequently conducted ; there were no other effects on the management of the pregnancy . There was no significant difference in fetal distress during labour ( odds ratio [ OR ] 0.96 ; 95 % confidence interval [ CI ] 0.70 - 1.33 ) . There were three times fewer perinatal deaths in the Doppler group ( three versus nine ) , but this difference was not significant ( OR 0.33 ; 95 % CI 0.06 - 1.33 ) . CONCLUSION Based on this trial routine use of umbilical doppler for low risk pregnancy can not be recommended . More data are needed to reach a definite conclusion of the value of routine Doppler OBJECTIVE To compare the accuracy of the reported date of the last menstrual period ( LMP ) with that of symphysis-fundal height ( SFH ) in the estimation of gestational age ( GA ) , using an ultrasound ( US ) scan as reference . METHODS Gestational age was concurrently assessed by the 3 methods in this prospect i ve , population -based , pregnancy- outcome study conducted in Hyderabad , Pakistan , from June 18 , 2003 , through August 31 , 2005 , with 1128 women between 20 and 26 weeks of a singleton pregnancy . RESULTS The mean GA was less by ultrasound than by SFH measurement or the reported LMP , and the mean differences with the US result were statistically significant ( P<0.001 for both ) . At delivery , about 75 % of the GA values estimated by SFH measurement were within 7 days and almost 91 % were within 14 days of the estimation by ultrasound , compared with 65 % and 82 % for the GA estimated by the reported LMP . Moreover , using the US as reference , the SFH correctly classified 84 % of the term , 68 % of the preterm , and 86 % of the post-term deliveries ( weighted kappa=0.58 ) compared with the corresponding 79 % , 61 % , and 55 % predicted by the reported LMP ( weighted kappa=0.44 ) . CONCLUSION The SFH measurement was found to be more accurate than the reported LMP as a tool to estimate GA and therefore date of delivery , but neither were as accurate as a US scan Abstract Despite widespread application of ultrasound imaging and Doppler blood flow studies , the effects of their frequent and repeated use in pregnancy have not been evaluated in controlled trials . From 2834 women with single pregnancies at 16 - 20 weeks gestation , 1415 were selected at r and om to receive ultrasound imaging and continuous-wave Doppler flow studies at 18 , 24 , 28 , 34 , and 38 weeks gestation ( the intensive group ) and 1419 to receive single ultrasound imaging at 18 weeks ( the regular group ) . Outcome data was obtained from 99 % of women who entered the study . The only difference between the two groups was significantly higher intrauterine growth restriction in the intensive group , when expressed both as birthweight 342 : Objective To assess the addition value of umbilical artery Doppler ultrasound added to st and ard ultrasound biometry measurements in the management of twin pregnancies A r and omized clinical trial was performed to test the hypothesis that if suspected intrauterine growth retardation ( IUGR ) is associated with normal umbilical artery Doppler ultrasound findings , hospitalization can safely be avoided . One hundred and fifty women with singleton pregnancies and suspected IUGR were r and omized between an intervention ( n = 74 ) and a control group ( n = 76 ) . In the intervention group , clinicians were strongly requested not to hospitalize for suspected IUGR if the Doppler findings were normal . In the control group , the Doppler results were not revealed and the participants received the st and ard management for suspected IUGR . Endpoints of the trial were : costs in terms of hospitalization , perinatal outcome , neurological development , and postnatal growth . Duration of hospitalization was significantly shorter in the intervention group than in the control group . Contrary to expectations , the hospitalization rate during pregnancy in the intervention group was not below that of the control group . This negative finding was partly due to the admission of patients in the intervention group despite their normal Doppler results . Moreover , the trial might have induced a more critical attitude towards hospitalization in suspected IUGR , decreasing admission in the control group . No clear differences were found in perinatal outcome , neurological development , or postnatal growth . The results suggest that normal umbilical artery Doppler findings in suspected cases of IUGR justify outpatient management Objective — To test whether the introduction of Doppler waveform analysis into the ultrasound department of a tertiary level hospital reduces neonatal morbidity and improves obstetric management OBJECTIVE To determine whether knowledge of the result of Doppler velocimetry of the umbilical artery is beneficial to the management of a high risk pregnancy . DESIGN R and omised controlled trial . The trial was of the management type , design ed to assess benefit accruing from additional information supplied by Doppler velocimetry . SETTING Tygerberg Hospital , Cape Town , South Africa . The hospital serves a population from the lower socio-economic groups . SUBJECTS Women with pregnancies 28 or more weeks gestation with hypertensive diseases and /or suspected small for gestational age fetuses were referred for Doppler velocimetry .  From this population , three subsets were formed : 1 . those with fetuses with absent end-diastolic velocities ( 20 fetuses ) ; 2 . those with hypertension but with fetuses with end-diastolic velocities ( 89 fetuses ) ; and 3 . those with fetuses suspected of being small for gestational age but with end-diastolic velocities ( 104 fetuses ) . INTERVENTIONS Doppler velocimetry on all subjects . The study group consisted of 10 cases with absent end-diastolic velocities , 47 cases with hypertensive diseases with end-diastolic velocities and 51 cases with suspected small for gestational age fetuses but with end-diastolic velocities in which the result was revealed to the clinician . The control group consisted of 10 , 42 and 53 cases , respectively , in which the Doppler results were not revealed . All other routine investigations ( sonar and antenatal fetal heart rate monitoring 
    Output:
    
Results There was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being . (
1 ) Detection and triage of IUGR with the help of ( 1a ) maternal BMI screening , ( 1b ) symphysial-fundal height measurement and ( 1c ) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality .
Based on the Delphi , a combination of screening with maternal BMI , Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20 % respectively .
Conclusion There is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being .
Expert opinion suggests that detection and management of IUGR with the help of maternal BMI , symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20 %