Prediction of vaginal delivery by using intrapartum ultrasound – a prospective cohort study
Abstract
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.
Downloads
References
Cunningham, F.G., Leveno, K.J., Bloom, S.L., Spong, C.Y., Dashe, J.S., Hoffman, B.L., Casey, B.M., Sheffield, J.S. Normal labor. In: Cunningham, F.G., Leveno, K.J., Bloom, S.L., Spong, C.Y., Dashe, J.S., Hoffman, B.L., Casey, B.M., Sheffield, J.S. eds. Williams obstetrics. 24th ed. New York, NY: McGraw-Hill. 2014. P. 433-454.
Dupuis O. Birth simulator: reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification / O. Dupuis, R. Silveira, A. Zentner, A. Dittmar, P. Gaucherand, M. Cucherat, et al. // Am J Obstet Gynecol. 2005. 192. P. 868–874.
Akmal S. Intrapartum sonography to determine fetal head position / S. Akmal, E. Tsoi, N. Kametas, R. Howard, K.H. Nicolaides // J Matern Fetal Neonatal Med. 2002. 12. P. 172–177.
Molina F.S. Ultrasound in labor and delivery / F.S. Molina, K.H. Nicolaides // Fetal Diagn Ther. 2010. 27. P. 61-67.
Seaward P.G. International Multicentre Term Prelabor Rupture of Membranes Study: Evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term / P.G. Seaward, M.E. Hannah, T.L. Myhr, D. Farine, A. Ohlsson, E.E. Wang, et al. // Am J Obstet Gynecol. 1997. Vol. 177, N 5. P. 1024–29.
Westover T. Modern management of clinical chorioamnionitis / T. Westover, R.A. Knuppel // Infect Dis Obstet Gynecol. 1995. Vol. 3, N 3. P. 123–32.
Ying Lai C. Hong Kong Chinese women's experiences of vaginal examinations in labour / C. Ying Lai, V. Levy // Midwifery. 2002. Vol. 18, N 4. P. 296-303.
Barbera A.F. A new method to assess fetal head descent in labor with transperineal ultrasound / A.F. Barbera, X. Pombar, G. Perugino, D.C. Lezotte, J.C. Hobbins // Ultrasound Obstet Gynecol. 2009. 33. P. 313–9.
Henrich W. Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction / W. Henrich, J. Dudenhausen, I. Fuchs, A. Kamena, B. Tutschek // Ultrasound Obstet Gynecol. 2006. 28. P. 753–60.
Eggebø T.M. Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term / T.M. Eggebø, L.K. Gjessing, C. Heien, E. Smedvig, I. Økland, P. Romundstad, et al. // Ultrasound Obstet Gynecol. 2006. 27. P. 387–91.
Tutschek B. A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent / B. Tutschek, T. Braun, F. Chantraine, W. Henrich // BJOG. 2011. 118. P. 62–9.
Eggebø T.M. Sonographic prediction of vaginal delivery in prolonged labor: a two-center study / T.M. Eggebø, W.A. Hassan, K.Å. Salvesen, E. Lindtjørn, C.C. Lees // Ultrasound Obstet Gynecol. 2014. Vol. 43, N 2. P. 195-201.
Ghi T. Threedimensional ultrasound in monitoring the progression of labor: a reproducibility study / T. Ghi, E. Contro, A. Farina, M. Nobile, G. Pilu // Ultrasound Obstet Gynecol. 2010. 36. P. 500–506.
Molina F.S. What is the most reliable ultrasound parameter to assess fetal head descent? / F.S. Molina, R. Terra, M.P. Carrillo, A. Puertas, K.H. Nicolaides // Ultrasound Obstet Gynecol. 2010. Vol. 36, N 4. P. 493-9.
