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.

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

2017 ◽  
Vol 35 (07) ◽  
pp. 660-668 ◽  
Author(s):  
U. M. Reddy ◽  
C. C. Huang ◽  
T. C. Auguste ◽  
D. Bauer ◽  
R. T. Overcash ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Induction Of Labor ◽  
Stepwise Logistic Regression ◽  
Chronic Hypertension ◽  
Stepwise Logistic Regression Analysis ◽  
Maternal Characteristics ◽  
Nulliparous Women

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770). Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

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.

A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound

2015 ◽  
Vol 213 (3) ◽  
pp. 362.e1-362.e6 ◽  
Author(s):  
Tørbjorn Moe Eggebø ◽  
Charlotte Wilhelm-Benartzi ◽  
Wassim A. Hassan ◽  
Sana Usman ◽  
Kjell A. Salvesen ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Maternal Characteristics ◽  
Nulliparous Women

scholarly journals Prediction of vaginal delivery by using intrapartum ultrasound – a prospective cohort study

2019 ◽  
Keyword(s):  
Cohort Study ◽  
Vaginal Delivery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Demographic Data ◽  
Area Under The Curve ◽  
Operating Characteristics ◽  
Fetal Head ◽  
Nulliparous Women ◽  
First Stage Of Labor

Non-invasive transperineal ultrasound is used to detect the descent of the fetal head by measuring head-perineum distance (HPD) and angle of progression (AP). The aim of the study was to evaluate HPD and AP as predictors of vaginal delivery in the first stage of labor. Methods: A prospective cohort study was made in Riga Maternity Hospital in Latvia in 2016. In the study were included nulliparous women with singleton pregnancies in cephalic presentation. HPD and AP were measured using transperineal ultrasoud. Demographic data, delivery parameters and birth outcomes were collected. Results: Of 36 women enrolled in the study, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve was 0.865 (95% confidence interval (CI) 0.75-0.98) for the prediction of vaginal delivery using HPD as the test variable. The area under the curve was 0.877 (95% CI 0.77-0.99) using AP. All women delivered vaginally, if HPD was ≤40 mm (18 (50%) women). 8 (22.2%) of 18 women with HPD >40 mm delivered vaginally (P<0.001). 21 women of 22 (61.1%) with AP ≥105° delivered vaginally. In the other 14 (38.9%) women with AP <105° 5 delivered vaginally (P<0.001). Conclusions: Both HPD ≤ 40 mm and AP ≥ 105° are predictors for vaginal birth in the first stage of labor.

scholarly journals Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor

2021 ◽  
Author(s):  
tamar katzir ◽  
Yoav Brezinov ◽  
Ella Kharish ◽  
Shira Hadad ◽  
Edi Vaisbuch ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Real Life ◽  
Vacuum Extraction ◽  
Delivery Mode ◽  
Fetal Head ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Nulliparous Women ◽  
The Mean ◽  
Time To Delivery

Abstract Purpose To determine the validity of Intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. Methods Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3hours ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descend, measured by AOP change/hour (calculated from serial measurements) was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. Results Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153º±19 vs. 133º±17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127º was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1º±11.4º vs. 6.2º±6.3º, p < 0.001). Conclusion Ultrasound assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting mode and interval time to delivery in real-life clinical practice.

scholarly journals Sonographic assessment of fetal head deflexion using occiput: spine angle measured during first stage of labour and its role in predicting the mode of delivery among nulliparous women

2019 ◽  
Vol 8 (8) ◽  
pp. 3025
Author(s):  
Keerthi Somu ◽  
Sujatha B. S. ◽  
Shripad Hebbar ◽  
Shyamala G. ◽  
Muralidhar V. Pai
Keyword(s):  
Cesarean Section ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Mean Value ◽  
Fetal Head ◽  
Nulliparous Women ◽  
Active Labour ◽  
Study Population ◽  
The Mean

Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71).  The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.

scholarly journals Predictors of preference for caesarean delivery among pregnant women in Beijing

2017 ◽  
Vol 45 (2) ◽  
pp. 798-807 ◽  
Author(s):  
Hongwei Zhang ◽  
Jing Wu ◽  
Jessie Norris ◽  
Li Guo ◽  
Yifei Hu
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Cross Sectional Study ◽  
Delivery Mode ◽  
Cross Sectional ◽  
Nulliparous Women ◽  
Self Administered Questionnaire ◽  
Source Of Information ◽  
Type Of Delivery

Objective To evaluate factors associated with preference for caesarean or vaginal delivery among pregnant Chinese nulliparous and parous women. Methods In this cross-sectional study, a self-administered questionnaire was used to collect information on sociodemographic characteristics, preference/reasons for delivery mode, and knowledge of delivery complications. Results Of the 450 participants, 85 (18.9%) reported a preference for caesarean section (CS) pre-partum. Compared with women who would prefer a vaginal delivery, nulliparous women who preferred CS were more likely to be: ≥35 years; have no medical insurance; have had two or more pregnancies; have access to only one source of information about birthing options; knowledge of the complications of vaginal delivery and think doctors have no right to decide the type of delivery. For parous women who preferred CS, they were more likely to have had a previous caesarean delivery and live outside Beijing. Conclusions From this study conducted at a large, maternity centre in Beijing, the proportion of pregnant women with preference pre-partum for CS was moderate and their reasons were varied.

scholarly journals First-Trimester Uterine Artery Doppler for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndrome Study

2018 ◽  
Vol 36 (09) ◽  
pp. 930-935
Author(s):  
Suzanne Demers ◽  
Amélie Boutin ◽  
Cédric Gasse ◽  
Olivier Drouin ◽  
Mario Girard ◽  
...  
Keyword(s):  
Gestational Age ◽  
Uterine Artery ◽  
Prediction Models ◽  
False Positive Rate ◽  
First Trimester ◽  
Maternal Characteristics ◽  
Receiver Operating Characteristic Curves ◽  
Nulliparous Women ◽  
Positive Rate

Objective This study aimed to estimate the performance of first-trimester uterine artery (UtA) pulsatility index (PI) for the prediction of preeclampsia (PE). Study Design We conducted a prospective cohort study of nulliparous women with singleton gestation at 11 to 13 6/7 weeks. UtA-Doppler's was performed on both UtAs and the mean UtA-PI was reported in multiple of median (MoM) adjusted for gestational age. Using receiver operating characteristic curves and their area under the curves (AUC); we calculated the performance of UtA-PI for the prediction of PE. Proportional hazard models were used to develop prediction models combining UtA-PI and maternal characteristics. Results Out of 4,676 participants with completed follow-up, 232 (4.9%) developed PE, including 202 (4.3%) term and 30 (0.6%) preterm PE. Mean UtA-PI decreased with gestational age between 11 and 13 6/7 weeks (p < 0.001). First-trimester UtA-PI was associated with preterm (AUC: 0.69; 95% CI [confidence interval]: 0.57–0.80) but not with term (AUC: 0.52; 95% CI: 0.48–0.56) PE. UtA-PI combined with maternal characteristics could predict 45% of preterm PE at a false positive rate of 10%. Conclusion First-trimester UtA-PI decreases with gestational age between 11 and 13 6/7 weeks and is associated with the risk of preterm but not term PE.

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 Intrapartum ultrasound to predict vaginal labor: a prospective cohort study

2017 ◽  
Vol 6 (11) ◽  
pp. 4778
Author(s):  
Helene Ingeberg ◽  
Anna Miskova ◽  
Diana Andzane
Keyword(s):  
Cohort Study ◽  
Vaginal Delivery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Maternity Hospital ◽  
The Other ◽  
Operating Characteristics ◽  
Fetal Head ◽  
Nulliparous Women

Background: Non-invasive transperineal ultrasound has been used to detect the descent of the fetal head using head-perineum distance (HPD) and angle of progression (AOP). The aim was to evaluate HPD and AOP as predictors of vaginal delivery in the first stage of labor.Methods: This was a prospective cohort study in Riga Maternity Hospital in Latvia from May till August 2016. The study included only nulliparous women with singleton pregnancies and cephalic presentation. Ultrasound was used to measure HPD and AOP. Data was collected on demographics, labor parameters and outcome.Results: Of 36 women enrolled, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve for the prediction of vaginal delivery was 0.865 (95% confidence interval (CI) 0.75-0.98) using HPD as the test variable and the area under the curve was 0.877 (95% CI 0.77-0.99) for AOP. The median HPD was lower in the women delivering vaginally than in the women delivering by cesarean section (P<0.001). HPD was ≤40 mm in 18 (50%) women, of whom all delivered vaginally. HPD was >40 mm in the other 18 women, of whom 8 (22.2%) delivered vaginally (P<0.001). AOP was ≥105° in 22 (61.1%) women and, of these, 21 delivered vaginally. AOP was <105° in the other 14 (38.9%) women, of whom 5 delivered vaginally (P<0.001).Conclusions: HPD ≤40 mm and AOP ≥105° are both predictive of vaginal delivery in the first stage of labor.

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