OP07.02: Prediction of delivery mode using angle of progression, before onset of labour in nulliparous women at term

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery.

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OP22.04: Can the “angle of progression” as measured in nulliparous women before the onset of labor predict mode of delivery?

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.9464 ◽

2011 ◽

Vol 38 (S1) ◽

pp. 119-120

Author(s):

R. Levy ◽

E. Vaisbuch ◽

S. Zaks ◽

A. Ben Arie ◽

S. Perlman ◽

...

Keyword(s):

Mode Of Delivery ◽

Nulliparous Women ◽

Angle Of Progression

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Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0106 ◽

2014 ◽

Vol 0 (0) ◽

Author(s):

Geum Joon Cho ◽

Hye-Ri Hong ◽

Hyun-Joo Seol ◽

Bo Hae Koo ◽

Soon-Cheol Hong ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Cervical Length ◽

Nulliparous Women ◽

Intact Membrane ◽

The Relationship ◽

Angle Of Progression ◽

Spontaneous Onset

AbstractTo investigate the relationship between angle of progression (AoP) on ultrasonography at 37–40 weeks’ gestation and delivery within 7 days.This prospective study was conducted between January 2013 and May 2013 at Korea University Guro Hospital, Korea. Nulliparous women between 37/0 and 40/3 weeks’ gestation with a singleton fetus, intact membrane, and cephalic presentation from January 2013 to May 2013 were enrolled. To evaluate the cervical parameters of cervical length and AoP, transvaginal and transperineal ultrasonography were performed, respectively. We then assessed the relationship between cervical parameters and onset of labor within 7 days by multivariate logistic regression analysis.Women who underwent spontaneous onset of labor within 7 days had a significantly shorter cervical length and AoP than those who underwent labor after 7 days. Logistic regression analysis showed that a larger AoP was an independent predictor of spontaneous labor within 7 days.A larger AoP was significantly associated with spontaneous onset of labor within 7 days. These findings may be useful for counseling patients regarding the management of term pregnancies.

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Predicting the Mode of Delivery by Angle of Progression (AOP) before the Onset of Labor by Transperineal Ultrasound in Nulliparous Women

Current Women s Health Reviews ◽

10.2174/1573404815666191113153204 ◽

2020 ◽

Vol 16 (1) ◽

pp. 39-45 ◽

Cited By ~ 1

Author(s):

Priyanka Shankerappa Minajagi ◽

Sujatha Bagepalli Srinivas ◽

Shripad Hebbar

Keyword(s):

Caesarean Section ◽

Mode Of Delivery ◽

Antenatal Clinic ◽

Transperineal Ultrasound ◽

Multivariable Logistic Regression Analysis ◽

Fetal Head ◽

Labor Dystocia ◽

Nulliparous Women ◽

Fetal Position ◽

Angle Of Progression

Background: Prediction of the mode of delivery is crucial for better labour outcome. Recent studies suggest that the angle of progression (AOP), measured using transperineal ultrasound, can substantially aid the assessment of fetal head descent during labor, thereby predicting the mode of delivery. Objective: To assess the ability of the AOP measured by transperineal ultrasound to predict the mode of delivery in nulliparous women before the onset of labor. Methods: A prospective observational study was conducted at our hospital, of nulliparous women who had presented to the antenatal clinic at ≥ 38 weeks of gestation but not in labor. AOP was measured using transperineal ultrasonography and compared among the women having Caesarean section (CS) due to labor dystocia and vaginal delivery (VD). Various other confounding factors which increase the risk of caesarean section were analyzed. Results: Among total 120 nulliparous women, the mean AOP was narrower in patients undergoing CS (n = 28) compared to those with VD (n = 92) (91.6 ± 6.1° vs. 100.7 ± 6.9°; P < 0.01). Multivariable logistic regression analysis revealed that narrow AOP values (OR 3.66; P < 0.001; 95% CI 1.7- 14.5) and occiput-posterior fetal position (OR 1.63; P = 0.04; 95% CI 1.0-7.5) were the independent risk factors for CS. An AOP ≥ 96° (calculated from the ROC curve) was associated with VD in 95% (76/80) of women and an AOP < 96° was observed among 60% (24/40) of women who underwent CS. Conclusion: Narrow AOP (< 96°) and occiput-posterior fetal position are at higher risk for CS due to labor dystocia. AOP measured at the antenatal period could accurately predict the mode of delivery, thereby modifying labor outcome.

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Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal Delivery

American Journal of Perinatology ◽

10.1055/s-0037-1608633 ◽

2017 ◽

Vol 35 (04) ◽

pp. 413-420 ◽

Cited By ~ 2

Author(s):

Caroline Rouse ◽

David Cantonwine ◽

Sarah Little ◽

Thomas McElrath ◽

Julian Robinson ◽

...

Keyword(s):

Vaginal Delivery ◽

Prospective Observational Study ◽

Mode Of Delivery ◽

Transperineal Ultrasound ◽

Survival Models ◽

Spontaneous Vaginal Delivery ◽

Second Stage Of Labor ◽

Second Stage ◽

Nulliparous Women ◽

Angle Of Progression

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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Effect of second child intent on delivery mode after Chinese two child policy implementation: a cross sectional and prospective observational study of nulliparous women in Chongqing

BMJ Open ◽

10.1136/bmjopen-2017-018823 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018823 ◽

Cited By ~ 16

Author(s):

Jianlin Zhao ◽

Nan Shan ◽

Xiaochang Yang ◽

Qin Li ◽

Yinyin Xia ◽

...

Keyword(s):

Observational Study ◽

Caesarean Delivery ◽

Prospective Observational Study ◽

Delivery Mode ◽

Second Trimester ◽

Cross Sectional ◽

Second Child ◽

Nulliparous Women ◽

Child Policy ◽

Tertiary Teaching

ObjectivesTo assess the influence of second child intent on the delivery preferences and final delivery modes of nulliparous women, particularly caesarean delivery on maternal request (CDMR), after implementation of China’s two child policy.DesignCross sectional and prospective observational study.SettingA tertiary teaching hospital in Chongqing, China.Participants1000 low risk nulliparous women were initially involved, and were divided into two groups based on their intent on having a second child. 814 women who completed all interviews were analysed.Main outcome measuresPreferred mode of delivery in second trimester and at admission; final delivery mode, CDMR.Results814 women who completed all interviews were analysed, in whom 51.2% intended to have a second child. The preference for caesarean delivery (CD) at the second trimester between the intent and no intent group was 6.2% versus 17.9% (adjusted RR 0.35, 95% CI 0.20 to 0.63) and increased to 24.2% versus 37.3% (adjusted RR 0.65, 95% CI 0.45 to 0.94) at admission, respectively. The overall CD rates between the two groups were 41.0% versus 50.4% (adjusted RR 0.84, 95% CI 0.60 to 1.18), and the CDMR rates were 16.7% versus 29.0% (adjusted RR 0.56, 95% CI 0.37 to 0.86), respectively.ConclusionsWomen who intend to have a second child are less likely to request a CD, and high rates of CD and CDMR in nulliparous women may have decreased after implementation of China’s two child policy.

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Simple models to predict vaginal delivery and spontaneous fetal occiput rotation based on intrapartum ultrasound and maternal characteristics

10.22541/au.161788450.05377896/v1 ◽

2021 ◽

Author(s):

Cheng Chen ◽

Xiaoxing Zhang ◽

Xiaohan Guo ◽

Hangkai Bao ◽

Peiying Luo ◽

...

Keyword(s):

Vaginal Delivery ◽

Prediction Models ◽

Characteristic Curve ◽

Delivery Mode ◽

Maternal Height ◽

Fetal Head ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Latent Phase ◽

Simple Models

Objective: To develop the prediction models for identifying fetal occiput rotation and vaginal delivery based on intrapartum sonographic findings. Design: Prospective observational study. Setting: Hangzhou, China. Population: Nulliparous women with a singleton cephalic presentation at term. Methods: Serial intrapartum ultrasonography were performed in the latent phase (T1) and every three hours after that (T2, T3 and T4). The managing clinicians performed paired digital vaginal examinations to assess labor progress. Main Outcome Measures: Delivery mode and successful internal fetal head rotation to the occiput anterior (OA) position. Results: 614 women were included, of whom 524 underwent vaginal delivery, and 90 required cesarean section. The percentage of women with fetuses in non-occiput anterior position at the latent phase was 53.9% (331 cases), as 257 women underwent spontaneous rotation to OA position before delivery, 74 were with persistent occiput posterior or transverse position. We developed a model on the basis of the maternal height and middle angel to predict the spontaneous fetal occiput rotation, with the area under the receiver operating characteristic curve (AUC) was 0.667 (95%CI 0.583-0.751). Moreover, a prediction model based on the maternal height and angle of progression to evaluate whether women underwent vaginal delivery was also developed, of which the AUC was 0.738(95% CI: 0.763-0.793). Both models showed satisfactory calibration. Conclusion: Simple models based on maternal characteristics and intrapartum ultrasound findings might provide useful information for predicting vaginal delivery and internal fetal occiput rotation.

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