ANTENATAL FETAL ASSESSMENT 0095-5108/94 $0.00 + .20 VELOCIMETRY Where Does It Belong In Evaluation Of Fetal Status? George Farmakides, MD, PhD, Zeev Weiner, MD, Michael Mammapoulos, MD, and Petros Nikolaides, MD Fitzgerald and Drumm 30 were the first to report on the application of Doppler in fetal circulation. Despite many papers written on the importance of velocimetry in the evaluation of the fetus, controversy remains as to where Doppler velocimetry fits in that process. The American College of Obstetrics and Gynecology (ACOG) opinion bulletin 1 states that Doppler velocimetry remains an investigational tool with the exception of situations in which absent end diastolic velocity (AEDV) is present in the umbilical artery. In such cases, they claim that Doppler velodmetry can play some role in the evaluation of the fetus. Despite that, in the interest of quality assessment and improvement in obstetric/gynecologic care, departmental consent forms list Doppler veloci- metry as a special procedure of which a doctor should have knowledge, expertise, and continued performance. 48 The discrepant positions taken in the obstetric community on the usefulness of Doppler velocimetry in fetal evaluation probably are due to a combination of factors, including study design, the investigators' anticipated results, and the way in which Doppler is used in the evaluation of the fetus. Six randomized controlled trials (2102 high-risk patients)2,17,37, 4 3, 4 s, 46 , 62 found that Doppler velocimetry measured perinatal mortality and intra- uterine death as well as serving as a subjective performance indicator for cesarian section (C/S), fetal distress, elective deliveries, and admission to the neonatal intensive care unit (NICU). Using the statistical method of From the Departments of Obstetrics and Gynecology, Winthrop University Hospital, Mineola (GF, ZW, MM, PN); and State University of New York, Stony Brook, New York (GF) CLINICS IN PERINATOLOGY VOLUME 21 •NUMBER 4 •DECEMBER 1994 849