scholarly journals The Usefulness of Intrapartum Transperineal Ultrasonography for the Prediction of Mode of Delivery

2020 ◽  
pp. 1
Author(s):  
Erdinc Saridogan ◽  
Ozlem Moraloglu Tekin
Keyword(s):  
Pregnant Women ◽  
Low Cost ◽  
Mode Of Delivery ◽  
High Sensitivity ◽  
Delivery Mode ◽  
Vaginal Examination ◽  
Operating Characteristics ◽  
Fetal Head ◽  
Maternal Characteristics ◽  
Angle Of Progression

<p><strong>OBJECTIVE:</strong> We aimed to assess the accuracy of intrapartum transperineal ultrasonography that is non-invasive, easy to learn, rapid to perform, comfortable for pregnant women, and low-cost method to evaluate the progress of labor objectively.</p><p><strong>STUDY DESIGN:</strong> We evaluated two hundred-ten singleton pregnant women at term with cephalic presentation who went into active labor via intrapartum transperineal ultrasonography using the angle of progression and head-perineum distance. Maternal characteristics, conventional vaginal examination findings, mode of delivery, and neonatal results were noted. The data were compared using correlation and regression analysis.<br />RESULTS: The relationships between the descent of clinical fetal head station, the increase of angle of progression (p=0.001), and the decrease of head-perineum distance (p=0.001) were statistically significant. The receiver operating characteristics curve showed that measurement of angle of progression with &lt;110.5 degrees (p=0.001) and measurement of head-perineum distance with &gt;52.5 millimeters (p=0.001) were associated with emergent cesarean delivery. For the prediction of delivery mode, both angle of progression and head-perineum distance had high sensitivity and specificity.</p><p><strong>CONCLUSIONS:</strong> Intrapartum transperineal ultrasonography parameters were in agreement with each other and conventional vaginal examination for determination of delivery mode. Head-perineum distance was a parity-dependent measurement whilst angle of progression was parity-independent.</p>

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 Sonographic parameters for diagnosing fetal head engagement during labour

Ultrasound ◽  
2018 ◽  
Vol 26 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Yaw A Wiafe ◽  
Bill Whitehead ◽  
Heather Venables ◽  
Alexander T Odoi
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Vaginal Examination ◽  
Minimum Level ◽  
Operating Characteristics ◽  
Fetal Head ◽  
Ultrasound Parameters ◽  
Digital Vaginal Examination ◽  
Angle Of Progression

The purpose of this study was to investigate the diagnostic performance of the head–perineum distance, angle of progression, and the head–symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head–perineum distance, angle of progression, and head–symphysis distance for values correlating with digital vaginal examination head station. Using station 0 as the minimum level of head engagement, correlating cut-off values for head–perineum distance, angle of progression, and head–symphysis distance were obtained. Receiver operating characteristics were used in determining the diagnostic performance of these cut-off values for the detection of fetal head engagement. With head–perineum distance of 3.6 cm the sensitivity and specificity of sonographic determination of engaged fetal head were 78.7 and 72.3%, respectively. A head–symphysis distance of 2.8 cm also had sensitivity and specificity of 74.5 and 70.8%, respectively, in determining engagement, whilst an angle of progression of 101° was consistent with engagement by digital vaginal examination with 68.1% sensitivity and 68.2% specificity. Ultrasound shows high diagnostic performance in determining engaged fetal head at a head–perineum distance of ≤3.6 cm, head–symphysis distance of ≤2.8 cm, and angle of progression of ≥ 101°.

The Comparison of Intrapartum Sonographic Signs and Digital Examination in Fetus with Cephalic Presentation

2020 ◽  
Vol 103 (11) ◽  
pp. 1178-1184
Keyword(s):  
Pregnant Women ◽  
Cross Sectional Study ◽  
Head Position ◽  
Vaginal Examination ◽  
Fetal Head ◽  
Cross Sectional ◽  
Percent Agreement ◽  
Anterior Position ◽  
Fetal Head Position ◽  
Digital Vaginal Examination

Objective: The agreement of fetal head position examined by digital vaginal examination (DVE) and intrapartum sonographic signs (ISS) in pregnant women during labor. Materials and Methods: A cross-sectional study was conducted. Two hundred eight-term singleton pregnant women attending labor at Ramathibodi Hospital, Thailand with the fetal cephalic presentation, cervical dilatation of 4 to 8 cm, station –2 or below and no contraindication for DVE were enrolled. The DVE evaluating fetal head position was performed by the third-year obstetrical residents. After DVE, ISS via transabdominal ultrasound for determining fetal head position was obtained immediately by the first researcher. The DVE report and the ultrasonographic images of ISS were recorded separately. The fetal head position based on ISS was designated by the second researcher blinded to the DVE result. The agreement of DVE and ISS for determining fetal head position was analyzed. Results: Two hundred eight pregnant women were analyzed. The fetal head position detected by DVE was consistent with that of ISS at 41.3% (p<0.001). The most percent agreement was observed in the fetus with left occiput anterior position at 72.7% (p<0.001). The lowest percent agreement was found in the direct occiput posterior at 14.3% (p=0.243). Parity, gestational age, current body mass index, epidural analgesia, cervical effacement, caput succedaneum, molding, and station did not significantly affect the discrepancy between DVE and ISS. Conclusion: The agreement between DVE and ISS for evaluating the fetal head position was low. The ISS might be considered for evaluating the fetal head position. Keywords: Fetal head position, Intrapartum sonographic sign, Digital vaginal examination

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 Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhifen Hua ◽  
Fadwa El Oualja
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Fetal Membrane ◽  
Delivery Mode ◽  
Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

scholarly journals Mode of Delivery in Drug-Dependent Pregnant Women: A Case Control Study

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ana Raquel Neves ◽  
Fabiane Neves ◽  
Isabel Santos Silva ◽  
Maria do Céu Almeida ◽  
Pitorra Monteiro
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Case Control Study ◽  
Mode Of Delivery ◽  
Case Control ◽  
Control Group ◽  
Maternal Characteristics ◽  
Drug Dependent ◽  
Route Of Delivery ◽  
Control Study

Objective. To determine the contribution of drug use during pregnancy to the route of delivery.Methods. A case-control study was conducted at a hospital in Coimbra, Portugal, between 2001 and 2014. Drug-dependent pregnant women (n=236) were compared with a control group of low risk women (n=228) in terms of maternal characteristics, obstetric history, pregnancy complications, and labor details. Factors that influenced the mode of delivery were determined. Statistical analysis was performed with SPSS v. 23.0 (IBM Corp.).pvalues < 0.05 were considered statistically significant.Results. Drug-dependent women presented a lower rate of cesarean delivery (18.2 versus 28.9%,p=0.006). After adjusting for the factors that were significantly related to the mode of delivery, drug dependency influenced the rate of cesarean section (β=0.567; 95% CI = 0.328–0.980). Within the drug-dependent group, the mode of delivery was significantly related to previous cesarean or vaginal delivery (p=0.008andp<0.001, resp.) and fetal presentation (p<0.001), but not with the type of drug, route of administration, or substitution maintenance therapy.Conclusions. The drug-dependent group presented a significantly higher rate of vaginal delivery. However, this was not associated with the behavioral factors analyzed. We hypothesize that other social and psychological factors might explain this difference.

scholarly journals Can angle of progression in pregnant women before onset of labor predict mode of delivery?

2012 ◽  
Vol 40 (3) ◽  
pp. 332-337 ◽  
Author(s):  
R. Levy ◽  
S. Zaks ◽  
A. Ben-Arie ◽  
S. Perlman ◽  
Z. Hagay ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Mode Of Delivery ◽  
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.

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

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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