Methods	Randomised controlled trial. Individual women.
Participants	Inclusion criteria Pregnant women, with singleton pregnancies, at 19-22 weeks pregnant. Unselected. Low- and high-risk pregnancies: high risk 189 in Doppler group and 192 in control group. 2600 women - 79% of eligible population. Exclusion criteria Multiple pregnancies.
Interventions	Experimental intervention: Doppler ultrasound of umbilical-artery and uterine-artery Multiple assessments at 20 and 32 weeks. Women with low-risk pregnancies had Doppler at booking and 32 weeks. Low risk for small-for-gestational age or other compromised infant. Women at high risk had ultrasound every month. High risk = women identified before entry into trial by: pre-existing medical condition, e.g. hypertension, diabetes, previous small for gestational age baby, previous stillbirth pr neonatal death, hypertension (BP > 140/90 mmHg) in previous pregnancy or at booking, smoking > 10a day. Any women in low-risk group who had abnormal Doppler was managed subsequently as high risk. If subsequent examination was normal the woman transferred back to low-risk group. Clinician could have Doppler at other times as requested. N = 1246. Control/Comparison intervention: no Doppler ultrasound Intended that women should not have Doppler US at anytime in pregnancy. Normal AN care with no Doppler. N = 1229. Multiple estimations were at 20 and 32 weeks’ gestation.
Outcomes	Number of days of antenatal admission; number of CTG recordings and US scans; gestational age at birth; mode of birth; birthweight; Apgar scores; need for resuscitation (intermittent positive pressure ventilation either via a mask or endotracheal tube); admission to NICU; fetal and neonatal outcomes The study was not designed to test the ability of Doppler ultrasound to reduce PNM, so the fact that there were more preventable deaths in the Doppler group is likely to be due to chance. However, the authors do theorise that it is possible that a woman’s knowledge of a normal result may have resulted in her taking less notice of symptoms that might otherwise have resulted in a review of fetal well-being
Notes	London (UK) 1992 study in previous version of the review (Bricker 2007).
Risk of bias
Item	Authors’ judgement	Description
Adequate sequence generation?	Unclear	No information provided.
Allocation concealment?	Unclear	“…cards in sealed opaque envelopes….” no mention of numbers sequence. The handbook says: “…sequentially numbered opaque sealed envelopes…” and that to be really sure “Envelopes were sequentially numbered and opened sequentially only after participants details were written on the envelope”
Incomplete outcome data addressed? All outcomes	Yes	Describe any loss of participants to follow up at each data collection point. Describe any exclusion of participants after randomisation: 125 women (4.8%) were excluded because: 106 gave birth elsewhere; 8 were randomised then found to have missed abortion; 2 multiple pregnancies; or because randomisation care (7), Doppler data (1) or hospital notes (1) went missing. Demographics similar to rest of study population . Was the analysis ITT? If not has the data been able to be re-included? Loss was small and unlikely to impact on outcomes.
Free of selective reporting?	Unclear	We did not assess the trial protocol.
Free of other bias?	Yes	If the study was stopped early, explain the reasons: Not stopped earlier. Describe any baseline in balance: “Women in the Doppler and the control groups did not differ in their demographic details (Table 1)”. So assessed by age, weight at booking, ethnic origins, nulliparous, smoking, shared antenatal care, high risk. 15 (1.2%) of the 1229 women in the control group had Doppler. Describe any differential diagnosis: Seems fine.