{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:00:10Z","timestamp":1791000010426,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The prediction of adverse perinatal outcomes in low\u2010risk pregnancies is poor, mainly owing to the lack of reliable biomarkers. Uterine artery (UtA) Doppler is closely associated with placental function and may facilitate the peripartum detection of subclinical placental insufficiency. The objective of this study was to evaluate the association of mean UtA pulsatility index (PI) measured in early labor with obstetric intervention for suspected intrapartum fetal compromise and adverse perinatal outcome in uncomplicated singleton term pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective multicenter observational study conducted across four tertiary maternity units. Low\u2010risk term pregnancies with spontaneous onset of labor were included. The mean UtA\u2010PI was recorded between uterine contractions in women admitted for early labor and converted into multiples of the median (MoM). The primary outcome of the study was the occurrence of obstetric intervention, i.e. Cesarean section or instrumental delivery, for suspected intrapartum fetal compromise. Secondary outcomes were the occurrence of adverse perinatal outcomes, including 5\u2010min Apgar score &lt;\u20097, low cord arterial pH, raised cord arterial base excess, admission to the neonatal intensive care unit (NICU) and postnatal diagnosis of small\u2010for\u2010gestational\u2010age fetus. Composite adverse perinatal outcome was defined as the occurrence of at least one of the following: acidemia in the umbilical artery, defined as pH &lt;\u20097.10 and\/or base excess &gt;\u200912\u2009mmol\/L, 5\u2010min Apgar score &lt;\u20097 or admission to the NICU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 804 women were included, of whom 40 (5.0%) had abnormal mean UtA\u2010PI MoM. Women who had an obstetric intervention for suspected intrapartum fetal compromise were more frequently nulliparous (72.2% <jats:italic>vs<\/jats:italic> 53.6%; <jats:italic>P<\/jats:italic>\u2009=\u20090.008), had a higher frequency of increased mean UtA\u2010PI MoM (13.0% <jats:italic>vs<\/jats:italic> 4.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.005) and had a longer duration of labor (456\u2009\u00b1\u2009221 <jats:italic>vs<\/jats:italic> 371\u2009\u00b1\u2009192\u2009min; <jats:italic>P<\/jats:italic>\u2009=\u20090.01). On logistic regression analysis, only increased mean UtA\u2010PI MoM (adjusted odds ratio (aOR), 3.48 (95%\u2009CI, 1.43\u20138.47); <jats:italic>P<\/jats:italic>\u2009=\u20090.006) and parity (aOR, 0.45 (95%\u2009CI, 0.24\u20130.86); <jats:italic>P<\/jats:italic>\u2009=\u20090.015) were independently associated with obstetric intervention for suspected intrapartum fetal compromise. Increased mean UtA\u2010PI MoM was associated with a sensitivity of 0.13 (95%\u2009CI, 0.05\u20130.25), specificity of 0.96 (95%\u2009CI, 0.94\u20130.97), positive predictive value of 0.18 (95%\u2009CI, 0.07\u20130.33), negative predictive value of 0.94 (95%\u2009CI, 0.92\u20130.95), positive likelihood ratio of 2.95 (95%\u2009CI, 1.37\u20136.35) and negative likelihood ratio of 0.91 (95%\u2009CI, 0.82\u20131.01) for obstetric intervention for suspected intrapartum fetal compromise. Pregnancies with increased mean UtA\u2010PI MoM also showed a higher incidence of birth weight &lt;\u200910<jats:sup>th<\/jats:sup> percentile (20.0% <jats:italic>vs<\/jats:italic> 6.7%; <jats:italic>P<\/jats:italic>\u2009=\u20090.002), NICU admission (7.5% <jats:italic>vs<\/jats:italic> 1.2%; <jats:italic>P<\/jats:italic>\u2009=\u20090.001) and composite adverse perinatal outcome (15.0% <jats:italic>vs<\/jats:italic> 5.1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.008).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study, conducted in a cohort of low\u2010risk term pregnancies enrolled in early spontaneous labor, showed an independent association between increased mean UtA\u2010PI and obstetric intervention for suspected intrapartum fetal compromise, albeit with moderate capacity to rule in, and poor capacity to rule out, this condition. \u00a9 2023 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26199","type":"journal-article","created":{"date-parts":[[2023,3,11]],"date-time":"2023-03-11T21:13:51Z","timestamp":1678569231000},"page":"219-225","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Uterine artery Doppler in early labor and perinatal outcome in low\u2010risk term pregnancy: prospective multicenter study"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-0206","authenticated-orcid":false,"given":"A.","family":"Dall'Asta","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma  Parma Italy"},{"name":"Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology Imperial College London  London 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