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The term RUPI\u2010L indicates a condition of \u201crelative\u201d uteroplacental insufficiency which is relative to a specific stressful circumstance, such as the onset of regular uterine activity. RUPI\u2010L may be more prevalent in fetuses in which the ratio between the fetal oxygen supply and demand is already slightly reduced, such as in cases of subclinical placental insufficiency, post\u2010term pregnancies, gestational diabetes, and other similar conditions. Prior to the onset of regular uterine activity, fetuses with a RUPI\u2010L may present with normal features on the cardiotocography. However, with the onset of uterine contractions, these fetuses start to manifest abnormal fetal heart rate patterns which reflect the attempt to maintain adequate perfusion to essential central organs during episodes of transient reduction in oxygenation. If labor is allowed to continue without an appropriate intervention, progressively more frequent, and stronger uterine contractions may result in a rapid deterioration of the fetal oxygenation leading to hypoxia and acidosis. In this Commentary, we introduce the term relative uteroplacental insufficiency of labor and highlight the pathophysiology, as well as the common features observed in the fetal heart rate tracing and clinical implications.<\/jats:p>","DOI":"10.1111\/aogs.14937","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T04:48:43Z","timestamp":1723006123000},"page":"1910-1918","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Relative uteroplacental insufficiency of labor"],"prefix":"10.1111","volume":"103","author":[{"given":"Tullio","family":"Ghi","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Fieni","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7706-3016","authenticated-orcid":false,"given":"Ruben","family":"Ramirez\u00a0Zegarra","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Pereira","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, The Royal London Hospital Barts Health NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-0206","authenticated-orcid":false,"given":"Andrea","family":"Dall'Asta","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5711-8515","authenticated-orcid":false,"given":"Edwin","family":"Chandraharan","sequence":"additional","affiliation":[{"name":"Global Academy of Medical Education and Training Ltd  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000525717"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2003.10.014"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2005.07.008"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00602.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002209"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.02.008"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17287"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.111720"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19110"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.03.026"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19113"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26199"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26287"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.11.016"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13319"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27534"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1987.tb02314.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1959.tb44593.x"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.2009.01064.x"},{"key":"e_1_2_11_21_1","unstructured":"Physiological CTG interpretation.Intrapartum Fetal Monitoring Guideline.2018. 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