The Angle of Progression: An Objective Assessment of Fetal Head Descent in the Birth Canal

2012 ◽  
pp. 87-100
Author(s):  
Antonino F. Barbera
Keyword(s):  
Objective Assessment ◽  
Fetal Head ◽  
Birth Canal ◽  
Angle Of Progression

The analysis of abdominal delivery cases at labor activity anomalies

2017 ◽  
pp. 103-106
Author(s):  
Yu.P. Vdovichenko ◽  
◽  
N.P. Goncharuk ◽  
E.Yu. Gurzhenko ◽  
◽  
...  
Keyword(s):  
Objective Assessment ◽  
Maternity Hospital ◽  
Professional Activity ◽  
Cesarean Sections ◽  
Birth Canal ◽  
Professional Management ◽  
Natural Birth ◽  
Abdominal Route ◽  
History Of ◽  
Abdominal Delivery

The objective: analysis of the frequency of cesarean sections, their structure according to the indications from the mother; study of the dynamics of the frequency of cesarean sections in case of abnormalities of labor activity (ALA) as indications for operative delivery on the basis of Kyiv City Maternity Hospital No. 1 for 2001-2011. Patients and methods. During the study, the frequency of cesarean sections in general, the frequency of urgent cesarean sections, the structure of cesarean sections according to the indications from the mother's side, the frequency of cesarean sections in ALA were studied and analyzed, and the dynamics of the cesarean section rate in ARP as well as one of the main indications with Mother's side. The history of the delivery of labor was used, which culminated in the abdominal route. Results. An increase in the level of cesarean sections was noted. The number of urgent cesarean sections is gradually decreasing. There has been a significant reduction in the incidence of cesarean sections in anomalies of labor, which are not amenable to drug treatment. Conclusion. The professional management of births, adequate justified use of medicines, the use of modern medical means in practice, an objective assessment of the obstetrical situation, cardiotocoagraphic support, timely and adequate use of epidural analgesia positively influenced the increase in the number of deliveries through the natural birth canal, which is a priority in the professional activity of the obstetrician-gynecologist. Key words: caesarian section, anomalies of labor activity.

scholarly journals Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

2018 ◽  
Vol 7 (8) ◽  
pp. 2998
Author(s):  
Hale Göksever Çelik ◽  
Engin Çelik ◽  
Gökhan Yıldırım
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Transperineal Ultrasound ◽  
Direct Visualization ◽  
Fetal Head ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
High Possibility ◽  
Angle Of Progression

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.

scholarly journals 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

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.

scholarly journals Maternal Outcome of among the Primigravida Women Presented with Fetal Head Engagement: Experience of 1440 Cases in Bangladesh

2019 ◽  
Vol 16 (2) ◽  
pp. 34-37
Author(s):  
Dewan Shahida Banu ◽  
Rifat Sultana ◽  
Mahmuda Khatun ◽  
Shafeya Khanam ◽  
Faiza Chowdhury ◽  
...  
Keyword(s):  
Wound Infection ◽  
Post Partum ◽  
Maternal Outcome ◽  
Fetal Head ◽  
Puerperal Sepsis ◽  
Birth Canal ◽  
Post Partum Hemorrhage ◽  
Medical College ◽  
Gynecology And Obstetrics ◽  
Number Of Patients

Background: Maternal outcome is an important issue among the primigravida women presented with fetal head engagement. Objectives: The purpose of the present study was to observe the maternal outcome of among the primigravida women presented with fetal head engagement. Methodology: This descriptive cohort study was carried out in the Department of Gynecology and Obstetrics at Sir Salimullah Medical College and Mitford Hospital, Dhaka from June 2006 to December 2006 for a period of sic (6) months. Primaigravida women with 38 or more weeks of pregnancy having single foetus with cephalic presentation were selected as study population. Maternal outcome was measured in terms of incidence of post-partum hemorrhage, injury to the birth canal, wound infection and puerperal sepsis. Result: A total number of 1440 pregnant women were recruited for this study. Maximum number of patients was in the age group of 21 to 24 years which was 897(62.29%). Post partum hemorrhage (PPH) was reported in 7(2.67%) cases in engaged group and 17(1.44%) cases in non-engaged group. Birth canal injury was recorded in 4(1.53%) cases and 12(1.02%) cases in engaged and non-engaged group respectively. Wound infection was found in 8(3.05%) cases and 81(6.88%) cases in engaged and non-engaged group respectively. Regarding puerperal sepsis it was found in 3(1.15%) cases and 11(0.93%) cases in engaged and non-engaged group respectively Conclusion: In conclusion PPH, birth canal injury, wound infection and puerperal sepsis are commonly found in non-engaged group Journal of Science Foundation 2018;16(2):34-37

scholarly journals Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise

2010 ◽  
Vol 35 (2) ◽  
pp. 216-222 ◽  
Author(s):  
A. M. Dückelmann ◽  
C. Bamberg ◽  
S. A. M. Michaelis ◽  
J. Lange ◽  
A. Nonnenmacher ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Transperineal Ultrasound ◽  
Fetal Head ◽  
Angle Of Progression

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

2020 ◽  
Vol 16 (1) ◽  
pp. 39-45 ◽  
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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