Objective To determine the accuracy of fetal umbilical artery Doppler for prediction of risk of compromise of fetal/neonatal wellbeing in a high risk population.

Design Systematic review with bivariate meta-analysis.

Data Sources Medline, Embase, Cochrane library, Medion (inception-March 2009), hand searching of relevant journals, reference list checking of included articles, contact with experts.

Eligibility Criteria for Selecting Studies Two reviewers independently selected articles without language restrictions. Criteria for selection were observational studies with umbilical artery Doppler used in a high risk pregnant population with an outcome measure for compromise of fetal/neonatal.

Results 104 studies met the selection criteria (19 191 fetuses). Umbilical artery Doppler showed better prediction of small for gestational age (pooled LR+ 3.76 (2.96, 4.76), pooled LR− 0.52 (0.45, 0.61)) and for compromise of fetal/neonatal wellbeing (pooled LR+ 3.41 (2.68, 4.34), pooled LR− 0.55 (0.48, 0.62)) in a high risk population. This group also showed useful accuracy for prediction of intrauterine death (pooled LR+ 4.37 (0.88, 21.8), pooled LR− 0.25 (0.07, 0.91)), acidosis (pooled LR+ 2.75 (1.48, 5.11), pooled LR− 0.58 (0.36, 0.94)) and admission to neonatal intensive care (pooled LR+ 3.35 (2.58, 4.36), pooled LR− 0.46 (0.39, 0.55)).

Conclusion Fetal umbilical artery Doppler is a moderately useful test in a high risk population to predict mortality and risk of compromise.