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Iliescu DG, Adam G, Tudorache S, Antsaklis P, Cernea N. Quantification of fetal head direction using transperineal ultrasound: an easier approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:607-608. [PMID: 22302748 DOI: 10.1002/uog.11117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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103
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Fouché CJ, Simon EG, Potin J, Perrotin F. Le suivi échographique de la deuxième partie du travail. ACTA ACUST UNITED AC 2012; 40:658-65. [DOI: 10.1016/j.gyobfe.2012.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 10/27/2022]
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104
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Simon EG, Fouché CJ, Perrotin F. Comment je fais… l’évaluation échographique de l’engagement. ACTA ACUST UNITED AC 2012; 40:625-7. [DOI: 10.1016/j.gyobfe.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 05/31/2012] [Indexed: 10/27/2022]
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Levy R, Zaks S, Ben-Arie A, Perlman S, Hagay Z, Vaisbuch E. Can angle of progression in pregnant women before onset of labor predict mode of delivery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:332-337. [PMID: 22605649 DOI: 10.1002/uog.11195] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The angle of progression (AOP), measured by transperineal ultrasound, has been used to assess fetal head descent during labor. Our aim was to assess whether, before onset of labor, parous women have a narrower AOP than do nulliparous women and if a narrow AOP is associated with a higher rate of Cesarean delivery. METHODS In this prospective, observational study, we performed transperineal ultrasound in pregnant women not yet in labor at ≥ 39 weeks' gestation who delivered within 1 week of sonography. The AOP was compared as follows: in nulliparous women, between those who had a Cesarean section and those who delivered vaginally; and among women who delivered vaginally, between those who were nulliparous and those who were parous. RESULTS Included in the study were 100 nulliparous and 71 parous women. Among those who delivered vaginally (n = 161), the median AOP before onset of labor was narrower in parous than in nulliparous women (98° (interquartile range (IQR)), 90-107° vs 104° (IQR, 97-113°), P < 0.001). Among the 100 nulliparous women, (1) the median AOP before onset of labor was narrower in those who went on to deliver by Cesarean section (n = 9) than in those delivered vaginally (n = 91) (90° (IQR, 85.5-93.5°) vs 104° (IQR, 97-113°), P < 0.001); (2) an AOP ≥ 95° (derived from the receiver-operating characteristics curve) was associated with vaginal delivery in 99% of women; and (3) 89% (8/9) of women who delivered by Cesarean section had an AOP < 95°. Among the 71 parous women, only one delivered by Cesarean section and all of those with an AOP < 95° delivered vaginally. CONCLUSION A narrow AOP (< 95°) in non-laboring nulliparous women at term is associated with a high rate of Cesarean delivery. Parous women have a narrower AOP than do nulliparous women before the onset of labor; however, unlike in nulliparous women, a narrow AOP in parous women does not appear to be associated with Cesarean delivery and most parous women with such an angle go on to deliver vaginally.
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Affiliation(s)
- R Levy
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to Hebrew University and Hadassah School of Medicine, Jerusalem, Israel.
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TORKILDSEN ERIKA, SALVESEN KJELLÅ, VON BRANDIS PHILIP, EGGEBØ TORBJØRNM. Predictive value of ultrasound assessed fetal head position in primiparous women with prolonged first stage of labor. Acta Obstet Gynecol Scand 2012; 91:1300-5. [DOI: 10.1111/j.1600-0412.2012.01503.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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107
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Sherer DM. Can sonographic depiction of fetal head position prior to or at the onset of labor predict mode of delivery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:1-6. [PMID: 22753319 DOI: 10.1002/uog.11213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY 11203, USA.
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Bamberg C, Rademacher G, Güttler F, Teichgräber U, Cremer M, Bührer C, Spies C, Hinkson L, Henrich W, Kalache KD, Dudenhausen JW. Human birth observed in real-time open magnetic resonance imaging. Am J Obstet Gynecol 2012; 206:505.e1-6. [PMID: 22425409 DOI: 10.1016/j.ajog.2012.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge about the mechanism of labor is based on assumptions and radiographic studies performed decades ago. The goal of this study was to describe the relationship between the fetus and the pelvis as the fetus travels through the birth canal, using an open magnetic resonance imaging (MRI) scanner. STUDY DESIGN The design of the study used a real-time MRI series during delivery of the fetal head. RESULTS Delivery occurred by progressive head extension. However, extension was a very late movement that was observed when the occiput was in close contact with the inferior margin of the symphysis pubis, occurring simultaneously with gliding downward of the fetal head. CONCLUSION This observational study shows, for the first time, that birth can be analyzed with real-time MRI. MRI technology allows assessment of maternal and fetal anatomy during labor and delivery.
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109
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Raia-Barjat T, Fanget C, Trombert B, Aouar Z, Chêne G, Varlet MN, Seffert P, Chauleur C. Étude préliminaire du diagnostic d’engagement par une échographie transpérinéale avant une extraction instrumentale. ACTA ACUST UNITED AC 2012; 41:346-52. [DOI: 10.1016/j.jgyn.2012.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/22/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
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110
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Bamberg C, Scheuermann S, Fotopoulou C, Slowinski T, Dückelmann AM, Teichgräber U, Streitparth F, Henrich W, Dudenhausen JW, Kalache KD. Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound. Am J Obstet Gynecol 2012; 206:161.e1-5. [PMID: 22177192 DOI: 10.1016/j.ajog.2011.10.867] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/18/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During labor, transperineal sonography is increasingly used to evaluate fetal head descent. The aim of this study was to compare the angle of progression assessed by open magnetic resonance imaging (MRI) vs transperineal ultrasound. STUDY DESIGN A total of 31 pregnant women at term (>37 weeks), who were not in labor, underwent MRI in an open 1.0-T system. A midsagittal plane of the maternal pelvis was stored. Immediately after, without changing the supine position, a transperineal ultrasound was performed. The angle of progression was measured offline by transperineal ultrasound and MRI. RESULTS The angles of progression measured by transperineal ultrasound (mean, 79.05 degrees; SD 11.44) and MRI (mean, 80.48 degrees; SD 11.06) correlated significantly (P < .001). The intraclass correlation coefficient between the 2 methods was 0.89 (95% confidence interval, 0.78-0.94). CONCLUSION The angle of progression measurements obtained by transperineal ultrasound and open MRI showed very good agreement.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany.
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111
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Ghi T, Youssef A, Pilu G, Malvasi A, Ragusa A. Intrapartum sonographic imaging of fetal head asynclitism. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:238-240. [PMID: 21523842 DOI: 10.1002/uog.9034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
Anterior asynclitism was suspected on digital examination of a laboring woman with late arrest of dilatation and no evidence of fetal head progression. Clinical examination revealed a fixed non-engaged fetal head (station −1), with a transverse posterior sagittal suture. A static three-dimensional volume was obtained by translabial ultrasound, offline analysis of which confirmed the clinical diagnosis of anterior asynclitism. Owing to the posterior twisting of the head towards the sacrum, the midline echo could only be obtained by cutting the volume with an oblique line, the direction of which was not perpendicular to the pubis as expected in cases of synclitic head. The sonographic appearance of the midline echo approaching the sacrum in a non-engaged transverse fetal head strongly supports the clinical suspicion of anterior asynclitism.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, S.Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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112
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Lau WL, Cho LY, Leung WC. Intrapartum translabial ultrasound demonstration of face presentation during first stage of labor. J Obstet Gynaecol Res 2011; 37:1868-71. [DOI: 10.1111/j.1447-0756.2011.01650.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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113
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Parikh R, Patel A, Stack T, Socrate S, House M. How the cervix shortens: an anatomic study using 3-dimensional transperineal sonography and image registration in singletons and twins. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1197-1204. [PMID: 21876090 DOI: 10.7863/jum.2011.30.9.1197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to use a fixed reference to study movement (displacement) of the cervical internal os from the second to the third trimester in singletons and twins. The rationale was to gain insight into anatomic changes associated with cervical shortening. METHODS For each patient, 2 transperineal scans were performed 12 weeks apart (20 and 32 weeks). The internal os and symphysis pubis were visualized in the same field of view. Image registration techniques were used to align the 2 scans using the symphysis as a fixed reference. Total displacement, anterior displacement, and inferior displacement of the internal os were measured. Displacements were correlated with cervical shortening. Bland-Altman plots and interobserver intraclass correlation coefficients were calculated. RESULTS A total of 42 healthy participants were studied: 28 with singletons and 14 with twins. The mean ± SD values for total displacement were 2.1 ± 1.2 and 2.0 ± 1.2 cm for singletons and twins, respectively (P = .75). The direction of displacement was significantly different. The mean anterior displacement was 1.1 cm greater for singletons than for twins (95% confidence interval, 0.29-2.0 cm, P = .01). Mean inferior displacement was 1.3 cm greater for twins than for singletons (95% confidence interval, 2.2-0.1 cm; P = .03). Only inferior displacement correlated with cervical shortening (P < .001; R(2) = 0.74). For every 2.2 cm of inferior displacement, the cervix shortened 1.0 cm. Assessments of reliability showed good agreement between 2 observers. CONCLUSIONS The anatomic position of the internal cervical os depends on gestational age and fetal number. Cervical shortening correlated most strongly with inferior displacement.
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Affiliation(s)
- Reshma Parikh
- Division of Maternal-Fetal Medicine, Tufts Medical Center, 800 Washington St, 360, Boston, MA 02111, USA
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114
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Dückelmann AM, Michaelis SAM, Bamberg C, Dudenhausen JW, Kalache KD. Impact of intrapartal ultrasound to assess fetal head position and station on the type of obstetrical interventions at full cervical dilatation. J Matern Fetal Neonatal Med 2011; 25:484-8. [DOI: 10.3109/14767058.2011.587057] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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115
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Torkildsen EA, Salvesen KÅ, Eggebø TM. Prediction of delivery mode with transperineal ultrasound in women with prolonged first stage of labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:702-708. [PMID: 21308837 DOI: 10.1002/uog.8951] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate if fetal head-perineum distance and angle of progression measured with two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound could predict outcome of labor in primiparous women with prolonged first stage of labor. METHODS This was a prospective observational study of 110 primiparous women with singleton cephalic presentation at term diagnosed with prolonged first stage of labor. Digital assessment of fetal station was related to the ischial spine. Fetal head descent was measured with transperineal ultrasound as the shortest distance from the fetal head to the perineum, and the angle between the pubic symphysis and the fetal head. Receiver-operating characteristics (ROC) curves were constructed and 2D and 3D data acquisitions were compared. The stored 3D volumes were assessed by an examiner blinded to all other data. Vaginal delivery vs. Cesarean section was the primary outcome. RESULTS Cesarean section was performed in 25% of the women. Areas under the ROC curves for prediction of vaginal delivery were 81% (95% confidence interval (CI), 71-91%) (P < 0.01) and 76% (95% CI, 66-87%) (P < 0.01) for fetal head-perineum distance and angle of progression, respectively, as measured by 2D ultrasound and 66% (95% CI, 54-79%) for digital assessment of fetal station (P = 0.01). In 50% of women fetal head-perineum distance was ≤ 40 mm and 93% (95% CI, 83-97%) of them delivered vaginally vs. 18% (95% CI, 5-48%) with distance > 50 mm. In 48% of women the angle of progression was ≥ 110° and 87% (95% CI, 75-93%) of them delivered vaginally vs. 38% (95% CI, 21-57%) with angle < 100°. Results from 2D and 3D acquisitions were similar. CONCLUSION Fetal head-perineum distance and angle of progression measured with 2D or 3D ultrasound can predict labor outcome, with similar predictive values for the two techniques.
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Affiliation(s)
- E A Torkildsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
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116
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Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN, Streitparth F, Teichgräber U, Henrich W, Dudenhausen JW, Kalache KD. Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:712-716. [PMID: 21308830 DOI: 10.1002/uog.8944] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term. METHODS Thirty-one pregnant women at full term with a fetus in the occipitoanterior position were enrolled. First, the distance between the leading part of the skull and the interspinal plane was obtained using an open MRI system with the patient in a supine position. Immediately after MRI, the angle of progression was obtained by transperineal ultrasound without changing the woman's posture. RESULTS There was a significant correlation between the angle of progression determined by transperineal sonography and the distance between the presenting fetal part and the level of the maternal ischial spines (y = - 0.51x + 60.8, r(2) = 0.38, P < 0.001). None of the fetal heads was engaged at the time of MRI and ultrasound examinations. CONCLUSIONS The present study demonstrated a predictable relationship between the angle of progression obtained by transperineal ultrasound and the traditional scale used to quantify fetal head descent. Based on our results, station 0 would correspond to a 120° angle of progression. However, this correlation is based on statistical assumptions only and has to be proven in future studies.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany
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117
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Tutschek B, Braun T, Chantraine F, Henrich W. A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent. BJOG 2010; 118:62-9. [DOI: 10.1111/j.1471-0528.2010.02775.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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118
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Molina FS, Terra R, Carrillo MP, Puertas A, Nicolaides KH. What is the most reliable ultrasound parameter for assessment of fetal head descent? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:493-499. [PMID: 20533441 DOI: 10.1002/uog.7709] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The aims of this study were, first, to establish the agreement between digital and ultrasound assessment of occipital position and, second, to evaluate the repeatability of the measurements of head direction, angle of the middle line, progression distance and angle of progression in women in the second stage of labor. METHODS Digital examination and then transabdominal ultrasound examination was performed on 50 women in the second stage of labor to determine the fetal occipital position. We also obtained three-dimensional (3D) blocks of the fetal head by transperineal sonography, and two experts in 3D ultrasound measured head direction, angle of the middle line, progression distance and angle of progression. Intraclass correlation coefficients with 95% CIs, and Bland-Altman analysis, were used to evaluate intraobserver and interobserver repeatability of measurements. RESULTS The fetal head position, determined by ultrasound examination, was occiput anterior in 33 (66%) cases and occiput lateral in 17 (34%) cases. Vaginal digital examination failed to identify the correct fetal head position by more than 45° in 33 (66%) cases. All four 3D ultrasound measurements were reproducible but the progression angle had the highest intraclass correlation coefficient for the same observer (0.94; 95% CI, 0.90-0.97) and for two different operators (0.84; 95% CI, 0.73-0.91). The progression angle was also the measurement for which smaller limits of agreement (LOA) were found in the Bland-Altman test, performed to calculate the intraobserver (bias 0.9; LOA, - 9.2 to 11.1%) and interobserver (bias 1.5; LOA, - 15.4 to 18.3%) variability. CONCLUSIONS Digital pelvic examination for determining the fetal head position during labor is not accurate. The most reproducible of the 3D measurements for progression of the fetal head in labor is the progression angle.
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Affiliation(s)
- F S Molina
- Department of Obstetrics and Gynaecology, University Hospital Virgen de las Nieves, Granada, Spain.
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119
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Ghi T, Contro E, Farina A, Nobile M, Pilu G. Three-dimensional ultrasound in monitoring progression of labor: a reproducibility study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:500-506. [PMID: 20652931 DOI: 10.1002/uog.7752] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the intraobserver and interobserver reproducibility of measurements, obtained from stored ultrasound volumes, related to fetal head progression in the birth canal. METHODS From January to September 2009, serial ultrasound volumes were obtained from women in labor, stored and separately evaluated by two different operators using the SonoVCAD™ labor software. Volumes were aligned using the pubic bone and the urethra as references. In the sagittal plane of the pelvis, the following data were calculated: head progression distance (the distance between the infrapubic line and the lowest part of the fetal skull), head direction (the angle between the infrapubic line and the major longitudinal axis of the fetal head) and head progression angle (the angle between the longitudinal axis of the pubic bone and a line joining the lowest edge of the pubis to the lowest convexity of the fetal skull). In the transverse plane, the angle formed by the midline with the anteroposterior axis of the maternal pelvis (midline angle) was also measured. For each measurement, intraobserver and interobserver reproducibility was determined. RESULTS We analyzed 30 ultrasound volumes. For all parameters, interobserver variation was significantly higher than intraobserver variation. Reproducibility was good for all parameters, except for the midline angle. Among the different ultrasound measurements, the progression angle presented the highest reproducibility. CONCLUSIONS Measurements obtained from stored ultrasound volumes to assess fetal head progression in the second stage of labor have good reproducibility, with progression distance and progression angle being the most reproducible parameters.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynaecology, University of Bologna, Bologna, Italy.
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120
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Dückelmann AM, Bamberg C, Michaelis SAM, Lange J, Nonnenmacher A, Dudenhausen JW, Kalache KD. Measurement of fetal head descent using the 'angle of progression' on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:216-222. [PMID: 20069668 DOI: 10.1002/uog.7521] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience. METHODS One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement. RESULTS In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93). CONCLUSIONS Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience.
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Affiliation(s)
- A M Dückelmann
- Department of Obstetrics, Charité University Hospital, Campus Benjamin Franklin and Campus Charité Mitte, Berlin, Germany
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Zimerman AL, Smolin A, Maymon R, Weinraub Z, Herman A, Tobvin Y. Intrapartum measurement of cervical dilatation using translabial 3-dimensional ultrasonography: correlation with digital examination and interobserver and intraobserver agreement assessment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1289-1296. [PMID: 19778874 DOI: 10.7863/jum.2009.28.10.1289] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy and reproducibility of intrapartum translabial 3-dimensional (3D) ultrasonographic measurements of cervical dilatation during labor. METHODS A prospective observational study was conducted. Three-dimensional ultrasonographic volume data sets from 52 patients were collected during labor and stored. Later, all volumes were randomly reviewed twice offline by 2 examiners blinded to previous clinical and ultrasonographic measurements. The correlation with delivery room personnel digital vaginal examinations and interobserver and intraobserver agreement were determined. RESULTS Twenty-four patients were examined during the latent phase (0- to 4-cm cervical dilatation), and 28 patients were examined during the active phase (5- to 10-cm cervical dilatation). Translabial 3D ultrasonographic measurements of the cervical mean and maximal diameters and inner cervical area showed a positive correlation with digital vaginal examinations (r(2) = 0.609, 0.587, and 0.469, respectively; all P < .001). The interobserver mean differences +/- SD between paired measurements for the mean and maximal cervical dilatation and inner cervical area were 0.11 +/- 0.49 cm, 0.12 +/- 0.48 cm, and -0.22 +/- 5.69 cm(2), and the intraclass correlation coefficients (ICCs) were 0.82, 0.85, and 0.87. The intraobserver mean differences between paired measurements of the mean and maximal cervical dilatation and inner cervical area were 0.002 +/- 1.15 cm, 0.02 +/- 1.4 cm, and -0.41 +/- 1.15 cm(2), and the ICCs were 0.85, 0.79, and 0.75. CONCLUSIONS Assessment of cervical dilatation using 3D ultrasonography during labor is feasible and reproducible.
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Affiliation(s)
- Ariel L Zimerman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, affiliated with the Sackler School of Medicine, Tel-Aviv University, Zerifin, Israel.
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Lau WL, Leung WC, Chin R. What is the best transperineal ultrasound parameter for predicting success of vacuum extraction? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:735-736. [PMID: 19434619 DOI: 10.1002/uog.6400] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Yeo L, Romero R. Sonographic evaluation in the second stage of labor to improve the assessment of labor progress and its outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:253-258. [PMID: 19247999 PMCID: PMC3138397 DOI: 10.1002/uog.6336] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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