Intrapartum ultrasound measurement of angle of progression at the onset of the second stage of labor for prediction of spontaneous vaginal delivery in term singleton pregnancies: a systematic review and meta-analysis

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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Angle of progression with trans-perineal ultrasound and delivery type in labor’s second stage; a cross-sectional study in Isfahan, Iran

Journal of Preventive Epidemiology ◽

10.34172/jpe.2022.05 ◽

2021 ◽

Vol 7 (1) ◽

pp. e05-e05

Author(s):

Elaheh Zarean ◽

Ferdos Mehrabian ◽

Mahsa Sadat Miri

Keyword(s):

Vaginal Delivery ◽

Induction Time ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Apgar Scores ◽

Spontaneous Vaginal Delivery ◽

Second Stage Of Labor ◽

Second Stage ◽

Angle Of Progression

Introduction: Numerous studies have shown that clinical evaluation in labor is not very accurate, therefore ultrasound is one of the instruments that can give us a more objective assessment than the clinical evaluation. Objectives: In this study, we investigate the magnitude of the angle of progression (AoP) at the second stage of labor in fetuses with cephalic presentation and its relation to spontaneous vaginal delivery. Patients and Methods: In this cross-sectional study, we measured the AoP using trans-perineal sonography in the 2nd stage of the labor and compared AoP in normal vaginal delivery (NVD), cesarean and NVD with vacuum groups on 80 pregnant women. We also investigated the correlation between AoP and induction time and duration of the second stage of labor. Results: In 80 study patients, 54 (67.5 %) had normal vaginal deliveries, 21 (26.2 %) had cesarean section and 5 (6.2%) had NVD with a vacuum. There was a statistically significant difference between NVD, cesarean section, and NVD with vacuum in terms of the AoP (P<0.01). There was a statistically significant correlation between AoP and induction time, duration of 2nd stage of labor and Apgar scores (P<0.05). Conclusion: Higher progression angle is associated with shorter induction time and 2nd stage of labor, higher neonatal Apgar scores and a higher chance of spontaneous vaginal delivery which makes it an appropriate index for predicting pregnancy outcomes.

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