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.

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

2017 ◽  
Vol 35 (04) ◽  
pp. 413-420 ◽  
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.

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 Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rawan A. Obeidat ◽  
Mahmoud Almaaitah ◽  
Abeer Ben-Sadon ◽  
Dina Istaiti ◽  
Hasan Rawashdeh ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Bishop Score ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Mean

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

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.

scholarly journals The Angle of Progression at Station 0 and in Magnetic Resonance and Transperineal Ultrasound Assessment

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
D. Iliescu ◽  
S. Tudorache ◽  
R. Dragusin ◽  
O. Carbunaru ◽  
C. Patru ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
High Resolution ◽  
Vaginal Delivery ◽  
Gold Standard ◽  
Transperineal Ultrasound ◽  
Fetal Head ◽  
Ultrasound Assessment ◽  
Mri Measurements ◽  
Angle Of Progression

The transperineal ultrasound (TPU) value of the angle of progression (AOP) during fetal head engagement, at station 0, is a critical cut-off for current obstetrical practice, especially when intrapartum instrumental interventions are required. Still, controversial measurements were reported in previous high resolution imagistic studies. Our TPU and direct “gold-standard” magnetic resonance (MRI) measurements confirm that station 0 corresponds to a 120° AOP, concordantly. Based on these findings, the fact that an AOP of 120° or greater was previously strongly associated with vaginal delivery may be due to the achievement of head engagement in labor.

scholarly journals Does Fetal Fibronectin Predict the Delivery Route in Nulliparous Women at Postterm Induced by Dinoprostone?

2019 ◽  
pp. 1
Author(s):  
Hale Goksever Celik ◽  
Engin Celik ◽  
Gonca Yetkin Yildirim
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Cervical Length ◽  
Vaginal Route ◽  
Fetal Fibronectin ◽  
Nulliparous Women ◽  
Significant Difference ◽  
Alternative Approaches ◽  
Delivery Route ◽  
High Possibility

<p><strong>Objective:</strong> Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, alternative approaches such as transperineal ultrasound, fetal fibronectin test in cervicovaginal secretions have been investigating for the prediction of the delivery route. We aimed to study whether the usefulness of qualitative fetal fibronectin test in cervicovaginal secretions for the prediction of vaginal delivery in pregnant women at postterm induced with dinoprostone.</p><p><strong>Study design:</strong> A total of 32 nulliparous pregnant women at postterm were enrolled in this prospective observational study. Fetal fibronectin test was applied to all participated women before the induction with dinoprostone and transvaginal ultrasonography was performed to measure cervical length.</p><p><strong>Results:</strong> The women having positive fetal fibronectin test result gave birth through vaginal route, except one case. Although there is no statistically significant difference, the shorter cervical length was associated with vaginal delivery in our population.</p><p><strong>Conclusion:</strong> Fetal fibronectin test has a predictive value for delivery route in nulliparous women at postterm. Fetal fibronectin test may be used as a “rule out” test because the rate of fetal fibronectin positivity was found to be higher in patients who gave birth via vaginal route. As also shown in our study, although there is no statistically significant difference, the pregnant women with shorter cervical length might have a high possibility to achieve vaginal delivery.</p>

scholarly journals Prediction of Vaginal Delivery Using Fetal Head Descent Assessed Using Transperineal Ultrasound

2017 ◽  
pp. 149 ◽  
Author(s):  
Yudianto B Saroyo ◽  
Mahendri D Danarti
Keyword(s):  
Vaginal Delivery ◽  
Obstet Gynecol ◽  
Active Phase ◽  
Transperineal Ultrasound ◽  
Inclusion Criteria ◽  
Fetal Head ◽  
Relaxation Phase ◽  
A Prospective Study ◽  
Distance Prediction ◽  
Angle Of Progression

Objective: To evaluate the use of transperineal ultrasound in predicting the successfulness of vaginal delivery. Methods: This was a prospective study conducted at Karawang District Hospital during the period between March 2016 and May 2016. Inclusion criteria were term pregnancy, singleton live head presentation, and active phase of labor. Using transperineal ultrasound, fetal head perineum distance, and angle of progression within relaxation phase between contraction were being calculated. Results: There were 306 subjects who delivered vaginally. The cut off value for fetal head perineum distance as a predictor of vaginal delivery was 43.5 mm (sensitivity 91%, specificity 78%), with area under a curve of 82% (95% CI 69 - 95%, p < 0.01); while angle of progression is 107° (sensitivity 80 %, specificity 97%), with Area under curve is 96.4% (95% CI 87 - 99%, p < 0.01). Conclusion: Fetal head perineum distance and angle of progression can predict the successfulness of vaginal delivery. [Indones J Obstet Gynecol 2017; 5-3: 149-153] Keywords: angle of progression, fetal head-perineum distance, prediction of vaginal delivery, transperineal ultrasound

scholarly journals Time of quickening is associated with the placental site and BMI in nulliparous women

2020 ◽  
Author(s):  
Negin Jaafar ◽  
Lars Henning Pedersen ◽  
Olav Bjørn Petersen ◽  
Lone Hvidman
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Prospective Observational Study ◽  
Nuchal Translucency ◽  
Second Trimester ◽  
Nulliparous Women ◽  
Placental Site ◽  
Fetal Movements ◽  
The Mean ◽  
Important Milestone

AbstractIntroductionQuickening, the first sensation of fetal movements, is an important milestone for pregnant women. Information on the expected gestational age at quickening may reduce anxiety and prevent delayed detection of intrauterine demise but the available data are from the 1980s before the emergence of modern ultrasound techniques.Materials and methodsProspective observational study on nulliparous women blinded for placental location in two hospitals in Denmark. The pregnant women were enrolled at the time of nuchal translucency scan, placental location was determined at time of second trimester scanning.. The women were blinded to placenta location before time of quickening. Time of quickening were reported by 122 women, 65 with an anterior and 57 with a posterior placenta. Thirteen women had a BMI >30 (10.7%).ResultsThe mean gestational age for quickening was 19 + 0 weeks for nulliparous women. The timing depended on placental site; women with an anterior placenta experienced quickening 6.4 days later than the women with a posterior placenta. BMI > 30 was associated with a later time of quickening.ConclusionsAnterior placental location is associated with delay in experience of fetal movements of 6.4 days and this may further be delayed in women with a BMI>30.

Anatomical Identification of Ischial Spines Applicable to Intrapartum Transperineal Ultrasound Based on Magnetic Resonance Imaging of Pregnant Women

2021 ◽  
Author(s):  
Eriko Yano ◽  
Takayuki Iriyama ◽  
Shouhei Hanaoka ◽  
Seisuke Sayama ◽  
Mari Ichinose ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pregnant Women ◽  
Vertical Plane ◽  
Pubic Symphysis ◽  
Transperineal Ultrasound ◽  
Anatomical Location ◽  
Ischial Spine ◽  
Resonance Imaging ◽  
Fetal Head

Abstract Intrapartum transperineal ultrasound (ITU) is considered useful in judging fetal head descent; however, the inability to detect ischial spines on ITU has been a drawback to its legitimacy. The current study aimed to determine the anatomical location of ischial spines, which can be directly applied to ITU. Based on magnetic resonance imaging of 67 pregnant women at 33+ 2 [31+ 6-34+ 0] weeks gestation (median [interquartile range: IQR]), we calculated the angle between the pubic symphysis and the midpoint of ischial spines (midline symphysis-ischial spine angle; mSIA), which is theoretically equivalent to the angle of progression at fetal head station 0 on ITU, by determining spatial coordinates of pelvic landmarks and utilizing spatial vector analysis. Furthermore, we measured symphysis-ischial spine distance (SID), defined as the distance between the vertical plane passing the lower edge of the pubic symphysis and the plane that passes the ischial spines. As a result, mSIA was 109.6 ° [105.1–114.0] and SID 26.4 mm [19.8–30.7] (median, [IQR]). There was no correlation between mSIA or SID and maternal characteristics, including physique. Our results provide valuable evidence to enhance the reliability of ITU in assessing fetal head descent by considering the location of ischial spines.

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