The ‘occiput-spine angle’: a new sonographic index of fetal head deflexion during first stage of labor as predictor of course of labor and outcome

Abstract Background Labor is a physiologic process during which the products of conception (i.e. the fetus, membranes, umbilical cord, and placenta) are expelled outside of the uterus. Labor is achieved with changes in the biochemical connective tissue and with gradual effacement and dilatation of the uterine cervix as a result of rhythmic uterine contractions of sufficient frequency, intensity, and duration. Labor is divided into three stages that include cervical dilatation, fetal delivery and delivery of the placenta. Objective The aims of this study were to quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor and to determine whether a parameter derived from ultrasound examination (the occiput-spine angle) has a relationship with the progress of labor, subsequent effect on maternal, fetal complications and rate of cesarean delivery. Methods This is a prospective cohort study which includes a total of 200 women with gestational age 37-42 weeks were assessed in this study in Ain shams Maternity hospital labor ward by 2 dimensional ultra sound. Examinations were performed after a verbal and written consent from the patient with the patient lying in the dorsal supine position. And exclusion of Occiput-posterior position, multigravida, Indication for cesarean, Medical disorder eg hypertension or diabetes, pre labor rupture of membranes to correlate between the Occiput- spine angle (OSA) and the outcome of labor regarding the progress of labor, incidence of cesarean section, maternal and fetal complications. Results This study demonstrates that the sonographic measurement of the angle formed by the fetal occiput and the spine (occiput-spine angle) is feasible and reproducible, the occiput-spine angle in the first stage of labor is positively correlated with the clinically established station and the risk of obstructed labor requiring an operative delivery ie, Occiput-spine angle have been statistically significantly lower in cases underwent operative delivery. Occiput-spine angle had a statistically significant low diagnostic performance in predicting operative delivery. Conclusion The occiput-spine angle in the first stage of labor correlates significantly with the risk of obstructed labor Compared with spontaneous vaginal deliveries, cases that require obstetric intervention demonstrated a smaller occiput-spine angle at a similar station, suggesting diminished flexion of the fetal head. For occiput anterior fetuses, the greater the degree of fetal head deflexion, the greater risk of operative delivery due to labor arrest.

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Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.9065 ◽

2012 ◽

Vol 39 (3) ◽

pp. 310-315 ◽

Cited By ~ 30

Author(s):

E. A. Torkildsen ◽

K. Å. Salvesen ◽

T. M. Eggebø

Keyword(s):

Three Dimensional ◽

Transperineal Ultrasound ◽

Fetal Head ◽

First Stage Of Labor

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Paper 25: The Impact of Occiput Posterior Fetal Head Position on the Risk of Anal Sphincter Injury in Forceps-Assisted Vaginal Deliveries

Journal of Pelvic Medicine and Surgery ◽

10.1097/01.spv.0000134086.77830.0a ◽

2004 ◽

Vol 10 ◽

pp. S10

Author(s):

L Benavides ◽

J M. Wu ◽

A F. Hundley ◽

T S. Ivester ◽

A G. Visco

Keyword(s):

Anal Sphincter ◽

Head Position ◽

Fetal Head ◽

Sphincter Injury ◽

Anal Sphincter Injury ◽

Vaginal Deliveries ◽

The Impact ◽

Fetal Head Position

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DZIKIR CAN REDUCE LABOR PAIN LEVEL

International Journal of Islamic Medicine ◽

10.37275/ijim.v2i1.22 ◽

2021 ◽

Vol 2 (1) ◽

pp. 26-30

Author(s):

Ai Nur Zannah

Keyword(s):

Physiological Condition ◽

Active Phase ◽

Labor Pain ◽

Pain Level ◽

Cervical Dilation ◽

Uterine Contractions ◽

Before And After ◽

Quasi Experimental ◽

Latent Phase ◽

First Stage Of Labor

Labor pain is a physiological condition that began at the first stage of labor (laten and active phase). Pain comes from uterine contractions and cervical dilation in an attempt to pave the way for birth and encourage babies to be born. Experts find pharmacological and non-pharmacological ways to reduce pain in labor, one of them is Dzikir guided by childbirth helper (midwife). The purpose of this study was to analyze the differences of labor pain level on mother in latent phase before and after applying Dzikir. Subjects were 15 accidentally selected mothers in labor latent phase on March - April in PMB “S” Puger Jember. The design of this study uses a quasi-experimental one group pre-posttest. Results showed significant decreased pain level of mothers after doing Dzikir significantly (Z=-3,578, p≤0.001). In conclusions, there are differences of labor pain level on mother in latent phase before and after applying Dzikir

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Obstetric Fistula and Common Peroneal Nerve Palsy in a Rural Based Women: A Case Report

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v14i1.22891 ◽

2015 ◽

Vol 14 (1) ◽

pp. 71-73

Author(s):

Suchanda Das ◽

Rokeya Begum ◽

Bidhan Roy Chowdhury

Keyword(s):

Vesicovaginal Fistula ◽

Obstetric Fistula ◽

Common Peroneal Nerve ◽

Home Delivery ◽

Obstructed Labor ◽

Labor Ward ◽

Comprehensive Health ◽

Common Peroneal Nerve Palsy ◽

Maternal And Newborn

Neglected obstructed labor is a major cause of both maternal and newborn morbidity and mortality. By far the most severe and distressing long term morbidity following obstructed labor is obstetric fistula i.e. Vesicovaginal fistula. In developing countries fistula is commonly the result of prolonged obstructed labor. A18 year old primi gravida was admitted in the labor ward with the involuntary passage of stool and urine and unable to walk after 15 days of her home delivery. Temporary colostomy was done. Patient was on regular physiotherapy for prolonged time and she was responded slowly. There was a plan for repair of Vesicovaginal and Rectovaginal fistula. Obstructed labor complex is completely preventable if high quality basic and comprehensive health services are available to all. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22891 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 71-73

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Effect of Intravenous Phloroglucinol Injections upon duration of Active First Stage of Labor

The International Journal of Frontier Sciences ◽

10.37978/tijfs.v4i2.246 ◽

2020 ◽

Vol 4 (2) ◽

pp. 69-71

Author(s):

Bilqees Akhtar Malik ◽

Ambreen Shabbir ◽

Zeb-Un-Nisa ◽

Asma Ambreen

Keyword(s):

Controlled Trial ◽

Military Hospital ◽

Control Group ◽

Singleton Pregnancy ◽

Uterine Contractions ◽

Multiparous Women ◽

History Of ◽

Group A ◽

Group B ◽

First Stage Of Labor

Objective: In our part of the world poverty and illiteracy has adversely affected our core objective of pregnancy i.e. healthy mother and healthy child. Exploring the role of a routinely used drug in reducing the duration of labor could be a breakthrough. Present study was planned accordingly to evaluate the effect of phloroglucinol (PHL). Materials and Methods: It was a Randomized controlled trial conducted at Department of Obstetrics & Gynecology, Combined Military Hospital, Bahawalpur from January 2019 to June 2019. This study included 60 cases of age 18 to 40 years, having singleton pregnancy and in active first stage of uncomplicated labor. Patients with history of multiple pregnancies, obstetrical and surgical complications and cardiorespiratory diseases were excluded. The cases were placed randomly into Group A & Group B and given intravenous PHL and a placebo respectively. After this, duration of the first stage of labor was recorded in minutes from when there was 3-4 cm cervical dilatation with regular uterine contractions to complete cervical dilation i.e. 10 cm and descent of the presenting fetal part. Results: Mean duration of active first stage of labor in experimental group A (230.20 ± 52.96 minutes) was significantly higher than that of control group B (345.30 ± 50.57 minutes). Conclusion: This study concluded that intravenous PHL has efficiently reduced the duration of active first stage of labor in these randomly selected nulliparous and multiparous women. PHL is a useful drug serving the purpose of a spasmolytic, analgesic and labor augmentation at the same time.

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Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study

BMC Pregnancy and Childbirth ◽

10.1186/1471-2393-13-106 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 16

Author(s):

Andrew Mujugira ◽

Alfred Osoti ◽

Ruth Deya ◽

Stephen E Hawes ◽

Amanda I Phipps

Keyword(s):

Cohort Study ◽

Head Circumference ◽

Population Based ◽

Operative Delivery ◽

Ethnic Population ◽

Fetal Head ◽

Fetal Outcomes

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The relation between head circumference and mid pelvic circumference: A simple index for cephalo-pelvic disproportion evaluation

Fetal Diagnosis and Therapy ◽

10.1159/000521115 ◽

2021 ◽

Author(s):

Gad Liberty ◽

Ofer Gemer ◽

Irena Siyanov ◽

Eyal Y. Anteby ◽

Alona Apter ◽

...

Keyword(s):

Head Circumference ◽

Odds Ratio ◽

Proof Of Concept ◽

Fetal Head ◽

Simple Index ◽

Bony Pelvis ◽

Cesarean Deliveries ◽

Simple Tool ◽

Vaginal Deliveries ◽

Concept Evaluation

Introduction: Cephalo-pelvic-disproportion (CPD) is one of the most common obstetric complications. Since CPD is the disproportion between the fetal head and maternal bony pelvis, evaluation of the head-circumference (HC) relative to maternal bony pelvis may be a useful adjunct to pre-labor CPD evaluation. The aim of the present study was a proof-of-concept evaluation of the ratio between HC to pelvic circumference (PC) as a predictor of CPD. Methods: Of 11,822 deliveries, 104 cases that underwent an abdomino-pelvic CT for any medical indication and who underwent normal vaginal deliveries (NVD) (n=84) or cesarean deliveries (CD) due to CPD (n=20) were included retrospectively. Maternal pelvis dimensions were reconstructed and neonatal HC, as a proxy for fetal HC, were measured. The correlation between cases of CPD and Cephalo-Pelvic Circumference Index (CPCI), which represents the ratio between the HC and PC in percent (HC/PC *100) was evaluated. Results: The mid-pelvis cephalo-pelvic circumference index (MP-CPCI) was larger in CD groups as compared to the NVD group: 103±11 vs. 97±8% respectively (p=0.0003). In logistic regression analysis, the MP-CPCI was found to be independently associated with CD due to CPD: each 1% increase in MP-CPCI increased the likelihood of CD for CPD by 11% (aOR 1.11, CI 95% 1.03-1.19, p=0.004). The adjusted odds ratio for CD due to CPD increased incrementally as the MP-CPCI increased, from 3.56 (95%CI, 1.01-12.6) at MP-CPCI of 100, to 5.6 (95%CI, 1.63-19.45) at 105, 21.44 (95%CI, 3.05-150.84) at 110, and 28.88 (95%CI, 2.3-362.27) at MP-CPCI of 115 Conclusions: The MP-CPCI, representing the relative dimensions of the fetal HC and maternal PC, is a simple tool that can potentially distinguish between parturients at lower and higher risk of CPD. Prospective randomized studies are required to evaluate the feasibility of prenatal pelvimetry and MP-CPCI to predict the risk of CPD during labor.

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Fetal Head Position during the First Stage of Labor: Comparison between Vaginal Examination and Transabdominal Ultrasound

ISRN Obstetrics and Gynecology ◽

10.1155/2014/314617 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Jyothi Shetty ◽

Vinod Aahir ◽

Deeksha Pandey ◽

Prashanth Adiga ◽

Asha Kamath

Keyword(s):

Head Position ◽

Transabdominal Ultrasound ◽

Vaginal Examination ◽

Fetal Head ◽

Kappa Test ◽

Tertiary Center ◽

Correct Determination ◽

Fetal Head Position ◽

First Stage Of Labor

Introduction. Recent evidence indicates that clinical examination, for determination of fetal head position, is subjective and inaccurate. Present study was aimed to compare transabdominal ultrasound for fetal head position with vaginal examination during first stage of labor. Material and Methods. This prospective study was performed at a tertiary center during a two-year period. Before or after clinically indicated vaginal examinations, transverse suprapubic transabdominal real-time ultrasound fetal head position assessment was done. Frequencies of various ultrasound depicted fetal head positions were compared with position determined at vaginal examination. Results. In only 31.5% of patients, fetal head position determinations by vaginal examinations were consistent with those obtained by ultrasound. Cohen’s Kappa test of concordance indicated a poor concordance of 0.15. Accuracy of vaginal examination increased to 66% when fetal head position at vaginal examination was recorded correct if reported within +45° of the ultrasound assessment. Rate of agreement between the two assessment methods for consultants versus residents was 36% and 26%, respectively (P=0.17). Conclusion. We found that vaginal examination was associated with a high error rate in fetal head position determination. Data supports the idea that intrapartum transabdominal ultrasound enhances correct determination of fetal head position during first stage of labor.

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