Key result
Elevated uterine artery pulsatility index in early labor is linked to nearly threefold higher intervention rates.
Why the study?
The relationship between uterine artery Doppler measured in early labour and perinatal and delivery outcomes in uncomplicated term pregnancies was unclear.
Does raised mean uterine artery Doppler PI predict adverse perinatal outcomes or obstetric interventions in low-risk term pregnancies in early labour?
Observational (n=804)
Single-blind
Yes
Does raised mean uterine artery Doppler PI predict adverse perinatal outcomes or obstetric interventions in low-risk term pregnancies in early labour?
Absolute Event Rate: 17.5% vs 6.2%
p-value: p=0.005
Raised mean uterine artery Doppler PI in early labour is associated with higher rates of obstetric intervention for fetal distress but is a poor predictor of composite adverse outcomes.
May warrant closer monitoring in high-PI labors; leaves open whether uterine artery Doppler improves risk stratification or outcomes in low-risk term pregnancies.
To evaluate the relationship between uterine artery (UtA) Doppler measured in early labour and perinatal and delivery outcomes in a cohort of uncomplicated singleton term pregnancies. Prospective multicentre observational study conducted at four tertiary centres between January 2016 and October 2019. Low-risk term pregnancies with spontaneous onset of labour were included. The UtA Doppler was bilaterally recorded in between uterine contractions in women admitted for early labour. The mean UtA Doppler was computed and converted into multiples of the median (MoM). Doctors and midwives involved in the clinical management of the women were blinded to the results of the Doppler evaluation. Mode of delivery and perinatal outcome were compared between pregnancies with raised mean UtA PI MoM, defined as mean UtA PI MoM above the 95th percentile of the study population, and those with normal mean UtA PI MoM. Overall, 804 women were included. The rate of obstetric intervention for suspected fetal distress in labour was almost three-fold higher among cases with raised mean UtA PI MoM compared to those with normal mean UtA PI MoM (7/40 (17.5%) vs 47/764 (6.2%); p = 0.005), however no difference was noted when evaluating composite adverse outcome (p = 0.24) between the two groups. Mean UtA PI MoM CPR showed low sensitivity and positive predictive value (13.0% and 17.5%, respectively) but high specificity and negative predictive value for obstetric intervention for suspected fetal distress (95.6% and 93.9%, respectively). Data on a wide cohort of low-risk term pregnancies in early labour showed an association between raised mean UtA PI MoM with an higher incidence of obstetric intervention due to fetal distress. However, mean UtA MoM proved to be a poor predictor of adverse outcome.
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Dall’Asta et al. (2020) conducted an observational in Uncomplicated singleton term pregnancies (n=804). Raised mean uterine artery (UtA) PI MoM vs. Normal mean UtA PI MoM was evaluated on Obstetric intervention for suspected fetal distress in labour (p=0.005). Raised mean uterine artery PI MoM in early labour was associated with a higher rate of obstetric intervention for suspected fetal distress compared to normal values (17.5% vs 6.2%; p=0.005).
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