{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T23:00:14Z","timestamp":1781650814196,"version":"3.54.5"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the predictive accuracy of selected umbilical artery (UA) pulsatility index (PI) reference charts for outcomes associated with placenta\u2010mediated fetal growth restriction (FGR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective cohort study of individuals with a singleton pregnancy who underwent UA Doppler assessment \u2265\u200920\u2009weeks' gestation between January 2012 and December 2022 at a single tertiary referral center, at which UA Doppler is measured routinely regardless of fetal size. Using 10 different UA\u2010PI reference charts, we compared the predictive accuracy of an abnormal UA\u2010PI (&gt;\u200995\n                      <jats:sup>th<\/jats:sup>\n                      \u2009percentile) for two primary outcomes that are considered specific and gestational\u2010age\u2010independent indicators of placenta\u2010mediated FGR: (1) late\u2010stage UA Doppler abnormalities (defined as absent or reversed end\u2010diastolic flow); and (2) maternal vascular malperfusion (MVM) on placental pathology. We also investigated the ability of these 10 charts to predict the secondary outcome of composite adverse perinatal outcome, defined as the presence of at least one of the following: stillbirth, 5\u2010min Apgar score &lt;\u20097, UA pH &lt;\u20097.1, need for neonatal resuscitation and\/or admission to the neonatal intensive care unit. Generalized estimating equations were used to calculate the predictive accuracy of the UA\u2010PI reference charts, accounting for repeated measurements within the same patient. To identify the best\u2010performing reference chart, we ranked each chart based on its Youden index at the 95\n                      <jats:sup>th<\/jats:sup>\n                      \u2009percentile cut\u2010off for UA\u2010PI for the two primary outcomes. Given the distinct phenotypes of early\u2010 and late\u2010onset FGR, we also performed an analysis stratified by gestational age at ultrasound examination (&lt;\u200932\n                      <jats:italic>vs<\/jats:italic>\n                      \u2265\u200932\u2009weeks).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 15\u2009841 patients, with 38\u2009398 ultrasound examinations, were included in the analysis. The\u00a0proportion of small\u2010for\u2010gestational\u2010age (SGA) fetuses classified as FGR based on an abnormal UA\u2010PI varied widely depending on which reference chart was applied, ranging from 2.2% to 25.7%. Similarly, the predictive accuracy of the 10 different reference charts for placenta\u2010mediated FGR outcomes differed considerably. The predictive performance for late\u2010stage UA Doppler abnormalities varied substantially across charts, with sensitivity ranging from 20.7% to 76.3% and specificity from 75.2% to 98.0%. Likewise, for the prediction of MVM on placental pathology, the sensitivity of the charts ranged from 6.8% to 42.0% and specificity from 77.5% to 98.6%. For most of the charts, sensitivity and specificity remained comparable between the overall cohort and gestational\u2010age subgroups. When ranked according to overall predictive performance for the two primary outcomes using the Youden index, the UA\u2010PI reference charts of Rahimi\n                      <jats:italic>et\u2009al.<\/jats:italic>\n                      , Drukker\n                      <jats:italic>et\u2009al.<\/jats:italic>\n                      and Flatley\n                      <jats:italic>et\u2009al.<\/jats:italic>\n                      demonstrated the best overall predictive accuracy. These same three charts retained the top performance ranking for the prediction of primary study outcomes in the subgroup of cases examined &lt;\u200932\u2009weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We observed substantial variation among 10 UA\u2010PI reference charts in both the proportion of SGA fetuses classified as growth restricted and the predictive accuracy of each chart for outcomes considered specific to placenta\u2010mediated FGR. Among the charts evaluated, those of Rahimi\n                      <jats:italic>et\u2009al<\/jats:italic>\n                      ., Drukker\n                      <jats:italic>et\u2009al<\/jats:italic>\n                      . and Flately\n                      <jats:italic>et\u2009al<\/jats:italic>\n                      . demonstrated the best overall performance for predicting all three study outcomes. If confirmed in external cohorts, these findings would support the ongoing efforts to standardize the diagnosis of FGR, which is crucial for both clinical and research purposes. \u00a9 2026 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70222","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T21:14:51Z","timestamp":1776719691000},"page":"783-794","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimal umbilical artery Doppler chart for predicting placenta\u2010mediated fetal growth 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University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Stratulat","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Temerty Faculty of Medicine University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Nevo","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine University of Toronto  Toronto ON 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