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Are low PAPP-A levels in first trimester related to the risk of fetal distress during labor, and fetal intrapartum acidemia? We prospectively considered patients requesting first-trimester biochemical screening for Down syndrome.Among the 1037 women enrolled, 152 (14.7%) had a low and 855 (85.3%) a normal first-trimester PAPP-A value.Excluding elective CS, 19/1 17 (16.2%) women with low vs.59/749 (7.9%) with normal PAPP-A underwent CS for concerning fetal status during labor (p=0.003;OR=2.27;CI95%: 1.30-3.97).This difference remained significant after correction for possible confounders (hypertension, pretem delivery, SGA, labor induction).Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs.normal PAPP-A (pH=7.19;range: 6.95-7.39 vs.pH=7.26;range: 7.02-7.39;p=0.022).Low PAPP-A levels at first trimester screening are independently associated with higher rates of emergency CS for non-reassuring fetal status during labor and lower pH.