Feto-maternal hemodynamics, cervical elastography and delivery outcomes at term

Objective: To evaluate the association between maternal hemodynamic patterns, cervical stiffness, and fetal Doppler indices with maternal and perinatal delivery outcomes in low-risk term women, and to identify potential clinical predictors. Methods: This prospective single-center study was conducted between May and September 2025 at Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Singleton pregnancies between 36 and 38 gestational weeks were included. Exclusion criteria were oocyte donation, chronic maternal diseases, pregnancy complications, or fetal anomalies.At recruitment, participants underwent transabdominal ultrasound including estimated fetal weight and fetal and uterine Doppler. Cervical strain elastography was performed using the E-Cervix software (Samsung HERA Z20), and cervical stiffness was assessed using the hardness ratio. Maternal hemodynamic patterns were evaluated using the Ultrasound Cardiac Output Monitor (USCOM). Maternal and neonatal outcomes were recorded at delivery.Associations between maternal hemodynamic patterns, cervical stiffness, fetal Doppler indices, and delivery outcomes were assessed using logistic regression and generalized linear models adjusted for relevant cofounders. Results: A total of 172 women were enrolled. Labor was induced in 55.2%; spontaneous vaginal, operative vaginal, and emergency cesarean deliveries occurred in 68.2%, 11.8%, and 20.0% of cases, respectively. Two hemodynamic profiles were identified: hyperdynamic (high CO, low SVR) and hypodynamic (low CO, high SVR). Birthweight was positively associated with the hyperdynamic profile (β = 85.6, 95% CI 38.7-132.6; p < 0.001) and negatively with the hypodynamic profile (β= -57.2, 95% CI -110- -4.3; p = 0.05). Maternal blood loss was lower in women with a hypodynamic pattern (β= -38.6, 95% CI -73.4- -3.9; p < 0.05). A hyperdynamic pattern increased the odds of unassisted vaginal delivery (aOR 1.33, 95%CI 1.01-1.66; p < 0.05), whereas a higher cervical hardness ratio reduced them (aOR 0.96, 95%CI 0.93-0.99; p < 0,05). Higher cerebroplacental ratio values were positively associated with umbilical cord arterial pH (β = 0.03, 95%CI 0.00-0.06; p = 0.05). Conclusions: In low-risk term pregnancies, integrated assessment of maternal hemodynamics, cervical elastography, and fetal Doppler may improve prediction of delivery outcomes. A hyperdynamic maternal profile was associated with higher birthweight and a greater likelihood ofunassisted vaginal delivery, whereas lower cervical stiffness was associated with increased odds of vaginal delivery.