Affiliation:
1. Department of Medicine and Surgery, Obstetrics and Gynecology Unit University of Parma Parma Italy
2. Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology Imperial College London London UK
3. Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust London UK
4. Fetal i+D Fetal Medicine Research Center, BCNatal–Barcelona Center for Maternal–Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS University of Barcelona Barcelona Spain
5. Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata University of Rome Tor Vergata Rome Italy
6. Department of Woman and Child Health, Maternal–Fetal Medicine Unit University of Padua Padua Italy
Abstract
ABSTRACTObjectiveThe prediction of adverse perinatal outcomes in low‐risk 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.MethodsThis was a prospective multicenter observational study conducted across four tertiary maternity units. Low‐risk term pregnancies with spontaneous onset of labor were included. The mean UtA‐PI 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‐min Apgar score < 7, low cord arterial pH, raised cord arterial base excess, admission to the neonatal intensive care unit (NICU) and postnatal diagnosis of small‐for‐gestational‐age 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 < 7.10 and/or base excess > 12 mmol/L, 5‐min Apgar score < 7 or admission to the NICU.ResultsOverall, 804 women were included, of whom 40 (5.0%) had abnormal mean UtA‐PI MoM. Women who had an obstetric intervention for suspected intrapartum fetal compromise were more frequently nulliparous (72.2% vs 53.6%; P = 0.008), had a higher frequency of increased mean UtA‐PI MoM (13.0% vs 4.4%; P = 0.005) and had a longer duration of labor (456 ± 221 vs 371 ± 192 min; P = 0.01). On logistic regression analysis, only increased mean UtA‐PI MoM (adjusted odds ratio (aOR), 3.48 (95% CI, 1.43–8.47); P = 0.006) and parity (aOR, 0.45 (95% CI, 0.24–0.86); P = 0.015) were independently associated with obstetric intervention for suspected intrapartum fetal compromise. Increased mean UtA‐PI MoM was associated with a sensitivity of 0.13 (95% CI, 0.05–0.25), specificity of 0.96 (95% CI, 0.94–0.97), positive predictive value of 0.18 (95% CI, 0.07–0.33), negative predictive value of 0.94 (95% CI, 0.92–0.95), positive likelihood ratio of 2.95 (95% CI, 1.37–6.35) and negative likelihood ratio of 0.91 (95% CI, 0.82–1.01) for obstetric intervention for suspected intrapartum fetal compromise. Pregnancies with increased mean UtA‐PI MoM also showed a higher incidence of birth weight < 10th percentile (20.0% vs 6.7%; P = 0.002), NICU admission (7.5% vs 1.2%; P = 0.001) and composite adverse perinatal outcome (15.0% vs 5.1%; P = 0.008).ConclusionOur study, conducted in a cohort of low‐risk term pregnancies enrolled in early spontaneous labor, showed an independent association between increased mean UtA‐PI and obstetric intervention for suspected intrapartum fetal compromise, albeit with moderate capacity to rule in, and poor capacity to rule out, this condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Subject
Obstetrics and Gynecology,Radiology, Nuclear Medicine and imaging,Reproductive Medicine,General Medicine,Radiological and Ultrasound Technology
Cited by
4 articles.
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