OP18.03: The longitudinal changes of the angle of progression and the midline angle in the active second stage according to the mode of delivery

Objective The objective of this study was to assess the association between the angle of progression (AoP) measured by transperineal ultrasound and mode of delivery and duration of the second stage. Study Design This is a prospective observational study of nulliparous women with a singleton gestation at term in which serial transperineal ultrasound examinations were obtained during the second stage of labor. Multivariable logistic regression and adjusted survival models were used for the analysis. Results A total of 137 patients were included in the analysis and median AoP for the study group was 153 degrees. The adjusted odds ratio (aOR) of requiring an operative delivery was 2.6 times higher for those patients who had an AoP < 153 degrees and the aOR of requiring a cesarean delivery was almost six times higher when compared with those patients who had an AoP ≥ 153 degrees (95% confidence interval [CI]: 1.0, 6.2; p = 0.04; aOR: 5.8, 95% CI: 1.2–28.3; p = 0.03, respectively). Those patients with an AoP < 153 degrees were at a higher hazard of staying pregnant longer (adjusted hazard ratio: 1.8, 95% CI: 1.2–2.8, p = 0.005). Conclusion The AoP has the potential to predict spontaneous vaginal delivery and the duration of the second stage of labor which may be useful in counseling patients and managing their labor.

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891: Angle of progression and its association with mode of delivery and duration of the second stage

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.11.800 ◽

2017 ◽

Vol 216 (1) ◽

pp. S509

Author(s):

Carolina Bibbo ◽

Caroline E. Rouse ◽

David E. Cantonwine ◽

Thomas F. McElrath ◽

Julian N. Robinson

Keyword(s):

Mode Of Delivery ◽

Second Stage ◽

Angle Of Progression

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Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery?

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.6294 ◽

2009 ◽

Vol 33 (3) ◽

pp. 326-330 ◽

Cited By ~ 123

Author(s):

K. D. Kalache ◽

A. M. Dückelmann ◽

S. A. M. Michaelis ◽

J. Lange ◽

G. Cichon ◽

...

Keyword(s):

Ultrasound Imaging ◽

Mode Of Delivery ◽

Transperineal Ultrasound ◽

Second Stage Of Labor ◽

Second Stage ◽

Angle Of Progression

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Longitudinal Changes in the Concentration of Major Human Milk Proteins in the First Six Months of Lactation and Their Effects on Infant Growth

Nutrients ◽

10.3390/nu13051476 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1476

Author(s):

Jian Zhang ◽

Ai Zhao ◽

Shiyun Lai ◽

Qingbin Yuan ◽

Xiaojiang Jia ◽

...

Keyword(s):

Human Milk ◽

Maternal Education ◽

Mode Of Delivery ◽

Milk Proteins ◽

Protein Composition ◽

Infant Growth ◽

Term Infants ◽

Longitudinal Changes ◽

Milk Samples ◽

The Impact

Our knowledge related to human milk proteins is still limited. The present study determined the changes in multiple human milk proteins during the first six months of lactation, investigated the influencing factors of milk proteins, and explored the impact of milk proteins on infant growth. A total of 105 lactating women and their full-term infants from China were prospectively surveyed in this research. Milk samples were collected at 1–5 days, 8–14 days, 1 month, and 6 months postpartum. Concentrations of total protein and α-lactalbumin were measured in all milk samples, and concentrations of lactoferrin, osteopontin, total casein, β-casein, αs−1 casein, and κ-casein were measured in milk from 51 individuals using ultra performance liquid chromatography coupled with mass spectrometry. The concentration of measured proteins in the milk decreased during the first six months of postpartum (p-trend < 0.001). Maternal age, mode of delivery, maternal education, and income impacted the longitudinal changes in milk proteins (p-interaction < 0.05). Concentrations of αs−1 casein in milk were inversely associated with the weight-for-age Z-scores of the infants (1 m: r −0.29, p 0.038; 6 m: r −0.33, p 0.020). In conclusion, the concentration of proteins in milk decreased over the first six months postpartum, potentially influenced by maternal demographic and delivery factors. Milk protein composition may influence infant weights.

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814: Nulliparous women in the second stage of labor: changes in neonatal outcomes over the past 10 years stratified by mode of delivery

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2014.10.1020 ◽

2015 ◽

Vol 212 (1) ◽

pp. S392

Author(s):

Joseph Fitzwater ◽

Nana-Ama Ankumah ◽

Sukhkamal Campbell ◽

Joseph Biggio ◽

John Owen ◽

...

Keyword(s):

Mode Of Delivery ◽

Neonatal Outcomes ◽

Second Stage Of Labor ◽

Second Stage ◽

The Past ◽

Nulliparous Women

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Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12712 ◽

2018 ◽

Vol 144 (2) ◽

pp. 192-198 ◽

Cited By ~ 6

Author(s):

Viola Y.T. Chan ◽

Wai-lam Lau ◽

Mike K.P. So ◽

Wing-cheong Leung

Keyword(s):

Second Stage Of Labor ◽

Second Stage ◽

Cesarean Deliveries ◽

Angle Of Progression

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489: Mode of delivery and neonatal outcomes in nulliparas with a prolonged second stage

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2015.10.532 ◽

2016 ◽

Vol 214 (1) ◽

pp. S267-S268 ◽

Cited By ~ 1

Author(s):

Todd Stanhope ◽

Methodius Tuuli ◽

Aaron Caughey ◽

George Macones ◽

Alison Cahill

Keyword(s):

Mode Of Delivery ◽

Neonatal Outcomes ◽

Second Stage

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The Assessment of Intrapartum Transperineal Ultrasonographic Parameters for their Effectiveness in Evaluation of Progress of Labor and Prediction of Mode of Delivery in Egyptian Women

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7049 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1037-1043

Author(s):

Gamal Abdelsameea Ibrahim ◽

Ahmed Soliman Nasr ◽

Fatma Atta ◽

Mohamed Reda ◽

Hend Abdelghany ◽

...

Keyword(s):

Vaginal Delivery ◽

Ultrasound Examination ◽

Mode Of Delivery ◽

Transperineal Ultrasound ◽

Ultrasound Measurement ◽

Vaginal Examination ◽

Fetal Head ◽

Prolonged Labor ◽

Digital Vaginal Examination ◽

Angle Of Progression

Introduction: High fetal head station has been associated with prolonged labor and delivery outcomes. Although clinical assessment of fetal head station is both subjective and unreliable, women with prolonged labor are subjected to multiple digital vaginal examinations. The use of ultrasound has been proposed to aid in the management of labor since 1990s. Ultrasound examination is more accurate and reproducible than clinical examination in the diagnosis of fetal head station and in the prediction of arrest of labor. Ultrasound examination can, to some extent, distinguish those women destined for spontaneous vaginal delivery and those destined for operative delivery and may predict the outcome of instrumental vaginal delivery. Such a technique has the potential to reduce the frequency of intrusive internal examinations and associated infection and could be useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated. Intrapartum ultrasound not only provides objective and quantitative data in labor, but also helps to make more reliable clinical decisions aiming to improve obstetric outcomes of both the mother and fetus as a supplementary tool for active management. Aim of the work: This study aims at assessing the value of intrapartum transperineal ultrasonography as a quantitative and objective tool in the evaluation of progress of labor and prediction of mode of delivery. Subjects: This study was a prospective observational study conducted on 600 primiparous women in active first stage of labor admitted to Kasr Al Ainy maternity hospital from January 2017 to June 2018. The studied population was divided into two groups. Group A of 300 women with normal progress of labor and group B of 300 women with prolonged 1st stage of labor. Methods: Fetal head station(FHS) was assessed clinically by digital vaginal examination (dVE) and sonographically by transperineal ultrasound measurement of head perineal distance (HPD) and angle of progression (AOP). Intrapartum care of the patient continued as normal based only on digital vaginal examinations using the modified WHO partogram. (1). Statistical analysis was targeted towards assessing the potential of the intrapartum ultrasonography in the evaluation of progress of labor and prediction of mode of delivery. Results: All studied parameters for assessment of FHS (dVE, HPD, and AOP) significantly corelated with each other and with both progress of labor and mode of delivery with P value (<0.001). The highest sensitivity for prediction of progress of labor is observed using dVE (83%), the highest specificity is observed using AOP (78.3%). The highest sensitivity for prediction mode of delivery is for combined HPD & AOP (97.7%) while the highest specificity is for AOP (81%). When combining both HPD and AOP for prediction of mode of delivery, the assessment of both parameters was found to have a high sensitivity of 97.7% and a high positive predictive value of 86.63%. Conclusion: Intrapartum ultrasound examination is a valuable tool in the prediction of progress of labor and mode of delivery. The assessment of fetal head station by transperineal ultrasound measurement of HPD and AOP is much more informative of the progress of labor and the mode of delivery than digital assessment of fetal head station. Keywords: Labor, intrapartum ultrasound, Angle of progression, Head perineal distance, fetal head station, digital vaginal examination.

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Upright kneeling position during second stage of labor: a pilot study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175930 ◽

2018 ◽

Vol 7 (2) ◽

pp. 401 ◽

Cited By ~ 1

Author(s):

Anjali Dabral ◽

Pallavi Pawar ◽

Rekha Bharti ◽

Archana Kumari ◽

Achla Batra ◽

...

Keyword(s):

Tertiary Care ◽

Mode Of Delivery ◽

Admission Rate ◽

North India ◽

Care Hospital ◽

Apgar Scores ◽

Second Stage Of Labor ◽

Second Stage ◽

Perineal Tears ◽

Second Stage Of Labour

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

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