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Usman S, Hanidu A, Kovalenko M, Hassan WA, Lees C. The sonopartogram. Am J Obstet Gynecol 2023; 228:S997-S1016. [PMID: 37164504 DOI: 10.1016/j.ajog.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 03/17/2023]
Abstract
The assessment of labor progress from digital vaginal examination has remained largely unchanged for at least a century, despite the current major advances in maternal and perinatal care. Although inconsistently reproducible, the findings from digital vaginal examination are customarily plotted manually on a partogram, which is composed of a graphical representation of labor, together with maternal and fetal observations. The partogram has been developed to aid recognition of failure to labor progress and guide management-specific obstetrical intervention. In the last decade, the use of ultrasound in the delivery room has increased with the advent of more powerful, portable ultrasound machines that have become more readily available for use. Although ultrasound in intrapartum practice is predominantly used for acute management, an ultrasound-based partogram, a sonopartogram, might represent an objective tool for the graphical representation of labor. Demonstrating greater accuracy for fetal head position and more objectivity in the assessment of fetal head station, it could be considered complementary to traditional clinical assessment. The development of the sonopartogram concept would require further undertaking of serial measurements. Advocates of ultrasound will concede that its use has yet to demonstrate a difference in obstetrical and neonatal morbidity in the context of the management of labor and delivery. Taking a step beyond the descriptive graphical representation of labor progress is the question of whether a specific combination of clinical and demographic parameters might be used to inform knowledge of labor outcomes. Intrapartum cesarean deliveries and deliveries assisted by forceps and vacuum are all associated with a heightened risk of maternal and perinatal adverse outcomes. Although these outcomes cannot be precisely predicted, many known risk factors exist. Malposition and high station of the fetal head, short maternal stature, and other factors, such as caput succedaneum, are all implicated in operative delivery; however, the contribution of individual parameters based on clinical and ultrasound assessments has not been quantified. Individualized risk prediction models, including maternal characteristics and ultrasound findings, are increasingly used in women's health-for example, in preeclampsia or trisomy screening. Similarly, intrapartum cesarean delivery models have been developed with good prognostic ability in specifically selected populations. For intrapartum ultrasound to be of prognostic value, robust, externally validated prediction models for labor outcome would inform delivery management and allow shared decision-making with parents.
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Lu Y, Zhou M, Zhi D, Zhou M, Jiang X, Qiu R, Ou Z, Wang H, Qiu D, Zhong M, Lu X, Chen G, Bai J. The JNU-IFM dataset for segmenting pubic symphysis-fetal head. Data Brief 2022; 41:107904. [PMID: 35198683 PMCID: PMC8842023 DOI: 10.1016/j.dib.2022.107904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
The use of transperineal ultrasound techniques for the assessment of fetal head descent and progression is an adjunct to clinical examination. Automatic identification of parameters based on ultrasound images will greatly reduce the subjectivity and non-repeatability of the clinician's judgment. However, the lack of a pubic symphysis-fetal head dataset hinders the development of algorithms. Here, we present an intrapartum transperineal ultrasound dataset of the Intelligent Fetal Monitoring Lab of Jinan University (named the JNU-IFM dataset), in which intrapartum transperineal ultrasound videos of 78 were recorded from 51 patients. These data were obtained with the Youkey D8 wireless 2D ultrasound probe with its corresponding supporting software by Wuhan Youkey Bio-Medical Electronics Co., Ltd., Wuhan, China. In these videos, 6224 high-quality images with four categories were selected to form the JNU- IFM dataset. These images were labelled using the Pair software and then validated by two experienced radiologists. We hope that this data set can be used in the segmentation of the pubic symphysis-fetal head.
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Hjartardóttir H, Lund SH, Benediktsdóttir S, Geirsson RT, Eggebø TM. Fetal descent in nulliparous women assessed by ultrasound: a longitudinal study. Am J Obstet Gynecol 2021; 224:378.e1-378.e15. [PMID: 33039395 DOI: 10.1016/j.ajog.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ultrasound measurements offer objective and reproducible methods to measure the fetal head station. Before these methods can be applied to assess labor progression, the fetal head descent needs to be evaluated longitudinally in well-defined populations and compared with the existing data derived from clinical examinations. OBJECTIVE This study aimed to use ultrasound measurements to describe the fetal head descent longitudinally as labor progressed through the active phase in nulliparous women with spontaneous onset of labor. STUDY DESIGN This was a single center, prospective cohort study at the Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland, from January 2016 to April 2018. Nulliparous women with a single fetus in cephalic presentation and spontaneous labor onset at a gestational age of ≥37 weeks, were eligible. Participant inclusion occurred during admission for women with an established active phase of labor or at the start of the active phase for women admitted during the latent phase. The active phase was defined as an effaced cervix dilated to at least 4 cm in women with regular contractions. According to the clinical protocol, vaginal examinations were done at entry and subsequently throughout labor, paired each time with a transperineal ultrasound examination by a separate examiner, with both examiners being blinded to the other's results. The measurements used to assess the fetal head station were the head-perineum distance and angle of progression. Cervical dilatation was examined clinically. RESULTS The study population comprised 99 women. The labor patterns for the head-perineum distance, angle of progression, and cervical dilatation differentiated the participants into 75 with spontaneous deliveries, 16 with instrumental vaginal deliveries, and 8 cesarean deliveries. At the inclusion stage, the cervix was dilated 4 cm in 26 of the women, 5 cm in 30 of the women, and ≥6 cm in 43 women. One cesarean and 1 ventouse delivery were performed for fetal distress, whereas the remaining cesarean deliveries were conducted because of a failure to progress. The total number of examinations conducted throughout the study was 345, with an average of 3.6 per woman. The ultrasound-measured fetal head station both at the first and last examination were associated with the delivery mode and remaining time of labor. In spontaneous deliveries, rapid head descent started around 4 hours before birth, the descent being more gradual in instrumental deliveries and absent in cesarean deliveries. A head-perineum distance of 30 mm and angle of progression of 125° separately predicted delivery within 3.0 hours (95% confidence interval, 2.5-3.8 hours and 2.4-3.7 hours, respectively) in women delivering vaginally. Although the head-perineum distance and angle of progression are independent methods, both methods gave similar mirror image patterns. The fetal head station at the first examination was highest for the fetuses in occiput posterior position, but the pattern of rapid descent was similar for all initial positions in spontaneously delivering women. Oxytocin augmentation was used in 41% of women; in these labors a slower descent was noted. Descent was only slightly slower in the 62% of women who received epidural analgesia. A nonlinear relationship was observed between the fetal head station and dilatation. CONCLUSION We have established the ultrasound-measured descent patterns for nulliparous women in spontaneous labor. The patterns resemble previously published patterns based on clinical vaginal examinations. The ultrasound-measured fetal head station was associated with the delivery mode and remaining time of labor.
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Kahrs BH, Usman S, Ghi T, Youssef A, Torkildsen EA, Lindtjørn E, Østborg TB, Benediktsdottir S, Brooks L, Harmsen L, Salvesen KÅ, Lees CC, Eggebø TM. Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:524-529. [PMID: 31115115 DOI: 10.1002/uog.20348] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. METHODS This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head-perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. RESULTS The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01-1.08). Mean ΔHPD was 7 mm (range, -10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5-min Apgar score < 7 and ΔHPD quartile. CONCLUSION Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B H Kahrs
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Usman
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Ghi
- Parma University Hospital, Parma, Italy
| | - A Youssef
- St Orsola Malpighi University Hospital, Bologna, Italy
| | - E A Torkildsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - E Lindtjørn
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - T B Østborg
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - S Benediktsdottir
- Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | - L Brooks
- Hvidovre University Hospital, Copenhagen, Denmark
| | - L Harmsen
- Hvidovre University Hospital, Copenhagen, Denmark
| | - K Å Salvesen
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T M Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Carvalho Neto RH, Viana Junior AB, Moron AF, Araujo Júnior E, Carvalho FHC, Feitosa HN. Assessment of the angle of progression and distance perineum-head in the prediction of type of delivery and duration of labor using intrapartum ultrasonography. J Matern Fetal Neonatal Med 2019; 34:2340-2348. [PMID: 31505974 DOI: 10.1080/14767058.2019.1666818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the relevance of the angle of progression (AOP) and head-perineum distance (HPD) for predicting the type of delivery and duration of the second stage of labor using intrapartum ultrasonography. METHODS In total, 221 women in labor with a single gestational sac at ≥37 weeks of gestation and fetuses in cephalic presentation underwent two-dimensional ultrasonography by transperineal route for measurements of AOP and HPD. Correlations between the type of delivery (vaginal or surgical (cesarean section and forceps)), duration of the second stage of labor, and fetal and maternal characteristics were assessed. AOP and HPD variables were separately studied in the first and second stages of labor. Multivariate logistic regression was followed in stages to identify the predictors for the surgical delivery outcome - stepwise forward method. RESULTS In total, 153 (69.2%) women underwent vaginal deliveries, 7 (3.2%) underwent forceps deliveries, and 61 (27.6%) underwent cesarean deliveries. AOP was a statistically significant parameter in first and second stages of labor (107.8 ± 12.1° versus 100.8 ± 13.7°; p = .017), with an inverse correlation with the occurrence of vaginal delivery. HPD was a statistically significant parameter in the second stage of labor (3.42 ± 0.84 cm versus 4.17 ± 0.54 cm; p < .003), with a direct correlation with the occurrence of surgical delivery. The value of AOP that optimized the curve was 129.9° with 85% specificity and 63% sensitivity for the vaginal delivery endpoint. The value of HPD that optimized the curve was 4.3 cm with 69% specificity and 89% sensitivity for the surgical delivery endpoint. In the first phase, the variables defining the type of delivery were the following: height, body mass index, and AOP. In the second phase, the variables defining were the following: height, labor analgesia, HPD, and position of the fetal occiput. CONCLUSION AOP and HPD determined by intrapartum ultrasonography were associated with duration of labor, which may aid in predicting the type of delivery in association with clinical parameters.
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Affiliation(s)
- Raimundo Homero Carvalho Neto
- Maternal Fetal Medicine Service, Assis Chateaubriand Maternity, Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Antonio Brazil Viana Junior
- Maternal Fetal Medicine Service, Assis Chateaubriand Maternity, Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Helvécio Neves Feitosa
- Maternal Fetal Medicine Service, Assis Chateaubriand Maternity, Federal University of Ceará (UFC), Fortaleza, Brazil.,Department of Obstetrics and Gynecology, University of Fortaleza (UNIFOR), Fortaleza, Brazil
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Iversen JK, Jacobsen AF, Mikkelsen TF, Eggebø TM. Structured clinical examinations in labor: rekindling the craft of obstetrics. J Matern Fetal Neonatal Med 2019; 34:1963-1969. [PMID: 31422727 DOI: 10.1080/14767058.2019.1651283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Exact knowledge of fetal station and position is of paramount importance for reliable surveillance of labor progress and a prerequisite for safe operative vaginal procedures. Detailed clinical assessments are thoroughly described in old textbooks, but almost forgotten in contemporary obstetrics. Ultrasound is suggested as an objective diagnostic tool in active labor. Several publications have demonstrated a low correlation between ultrasound and clinical assessment of fetal head station and position, but the methods of clinical assessment in these studies are poorly described. We wanted to explore if a quality clinical assessment could perform better than clinical assessment in previous publications, by analyzing the correlation between a structured method of clinical assessment and intrapartum ultrasound. METHODS In all, 100 laboring women with cervical dilatation ≥7 cm were included in a prospective cohort study at Oslo University Hospital-Ullevål from October to December 2016. The study design was cross-sectional. Clinical examinations were performed by one special educated consultant (JKI), and transabdominal and transperineal ultrasound clips were recorded and examined by a blinded expert in intrapartum ultrasound (TME). Fetal position was classified as a clock face with 12 units (hourly divisions) and thereafter categorized as occiput anterior (OA), left occiput transverse (LOT), occiput posterior (OP), and right occiput transverse (ROT) positions. Fetal station was categorized clinically from -5 to +5 and measured with ultrasound as angle of progression (AoP) and head-perineum distance (HPD). AoP is the angle between a longitudinal line through the symphysis and a tangent to the head contour. HPD is the shortest distance between the fetal skull and the perineum. RESULTS Eight women were excluded due to strong contractions between clinical assessments and ultrasound measurements, fetal distress, or incomplete examinations. Fetal position assessed with ultrasound and clinical examination agreed exactly in 48/92 (52%) of cases, within one unit (hour) in 87/92 (95%) of cases and within two units in 90/92 (98%) of cases. It differed by three units in one case and by five units in one case. The agreement categorized into OA, LOT, OP, and ROT was good (Cohen's kappa 0.72; 95% CI 0.61-0.84). For station, the agreement was very good for both HPD (Pearson correlation coefficient r = 0.86; 95% CI 0.80-0.91) and AoP (r = 0.77; 95% CI to 0.67-0.84). The correlation between HPD and AoP was good (r = 0.76; 95% CI 0.65-0.84). CONCLUSION We found very good correlations between structured clinical assessments and ultrasound examinations, suggesting that an objective quality in clinical examinations is possible to achieve. More focus on clinical skills training may improve accuracy for clinicians.
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Affiliation(s)
- Johanne Kolvik Iversen
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Flem Jacobsen
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Torbjørn Moe Eggebø
- Center for Fetal Medicine, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway.,Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Youssef A, Dodaro MG, Montaguti E, Consolini S, Ciarlariello S, Farina A, Bellussi F, Rizzo N, Pilu G. Dynamic changes of fetal head descent at term before the onset of labor correlate with labor outcome and can be improved by ultrasound visual feedback. J Matern Fetal Neonatal Med 2019; 34:1847-1854. [PMID: 31394944 DOI: 10.1080/14767058.2019.1651266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the dynamic changes of angle of progression (AoP) before the onset of labor and their correlation with labor outcome and to investigate the effect of visual feedback using transperineal ultrasound on maternal pushing. METHODS We recruited a group of low-risk nulliparous women with singleton pregnancy at term. We measured AoP at rest, during pelvic floor contraction and Valsalva maneuver (before and after visual feedback). We compared AoP between women who delivered vaginally (VD) and those who underwent a cesarean section (CS). We also assessed the correlation between AoP and labor durations. RESULTS Overall, 222 women were included in the study; 129 (58.1%) had spontaneous VD, 35 (15.8%) had instrumental delivery, and 58 (26.1%) underwent CS. In comparison with rest, AoP decreased at PFMC (p < .001) and increased at first Valsalva (p < .001). AoP increased further significantly at Valsalva after visual feedback (p < .001). Women with VD had wider AoP at rest (p = .020), during Valsalva maneuver before (p = .024), and after visual feedback (p = .037). At cox regression analysis, wider AoP was associated with shorter first, second, and active second stages. CONCLUSION Wider AoP at rest and under Valsalva is associated with vaginal delivery, the shorter interval to delivery, and shorter labor duration in nulliparous women at term. The accuracy of AoP in the prediction of cesarean delivery is modest and is unlikely to be clinically applicable in isolation for the prediction of the mode of delivery.
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Affiliation(s)
- Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Maria Gaia Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Elisa Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Consolini
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Ciarlariello
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Antonio Farina
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federica Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Ali J, Hebbar S. Ultrasound Assessment of Foetal Head-Perineum Distance Prior to Induction of Labour as a Predictor of Successful Vaginal Delivery. J Obstet Gynaecol India 2019; 69:129-135. [PMID: 30956466 DOI: 10.1007/s13224-018-1120-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/30/2018] [Indexed: 01/04/2023] Open
Abstract
Background In modern obstetrical practice, incidence of induction of labour is on rise for varied maternal and foetal indications. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. Objectives To study the role of foetal head-perineum distance in predicting successful vaginal delivery and to correlate with other parameters such as cervical length and Bishop score. Design This study is a prospective case-control study in a tertiary care teaching hospital. Population There were 250 term patients between 37 and 40+ weeks with singleton cephalic presentation with no contraindications for vaginal delivery. Methods Prior to induction of labour, transperineal ultrasound was performed to measure foetal head-perineum distance. Simultaneously, cervical length was performed using transvaginal ultrasound probe. Bishop score was determined at the same time by clinical examination. Main Outcome Measures Outcome of induction was considered successful when it resulted in vaginal delivery. It was considered to be a failure if patient did not get into active phase of labour or an operative intervention had to be performed because of non-progress of labour in active phase of labour. Cases were excluded if caesarean delivery had to be performed in the event of foetal distress. Results It was observed that as the transperineal foetal head-perineum distance decreased, the rate of vaginal delivery increased. Similarly, when foetal head-perineum distance increased, the rate of caesarean delivery increased. At a cut-off ≤ 5.5 cm, foetal head-perineum distance had a maximum predictability (sensitivity 97%, specificity 88.1%). Conclusion Transperineal foetal head-distance measured by ultrasound can be used as an important tool to predict vaginal delivery before induction of labour.
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Affiliation(s)
- Jijisha Ali
- Mediclinic Welcare Hospital, Garhoud, Dubai, United Arab Emirates
| | - Shripad Hebbar
- 2Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
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Assessment of fetal head engagement with transperineal ultrasound: Searching for the cutoff level. J Gynecol Obstet Hum Reprod 2018; 47:317-324. [PMID: 29793035 DOI: 10.1016/j.jogoh.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/13/2018] [Accepted: 05/17/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Engagement of the fetal head is a determinant element when deciding on operative vaginal delivery. In routine practice, engagement is a clinical diagnosis based on transvaginal digital examination. Transperineal ultrasound might provide complementary information useful for measuring the fetal head-perineum distance (HPD). The purpose of this work was to determine the cutoff HPD distinguishing engagement from non-engagement. MATERIALS AND METHODS This single-center prospective study approved by the institutional review board was conducted between December 25, 2012 and August 31, 2015 in 411 nulliparous women; 20 did not provide informed consent and were excluded; analysis concerned 391 patients. Clinical diagnosis - engagement or non-engagement depending on results of the transvaginal digital examination (Farabeuf's and Demelin's signs) - was compared with the ultrasound HPD measurement. RESULTS The clinical diagnosis was non-engagement at complete dilatation in 96 patients (24.6%). The cutoff HPD distinguishing between engagement and non-engagement was 57mm (AUC 83.5% [95%CI 79.3-87.8]), with 75.0% [65.5-82.6] sensitivity, 75.9% [70.7-80.5] specificity, 50.3% [42.2-58.4] positive predictive value, and 90.3% [86.0-93.4] negative predictive value. CONCLUSIONS In this series, the HPD cutoff distinguishing between engagement and non-engagement was 57mm. Below this cutoff level, the head should be considered engaged, beyond non-engaged. Nevertheless, the pertinence of this cutoff level is hampered by the imprecision of the gold standard used for the clinical diagnosis (transvaginal digital examination). In case of doubt, we recommend, in addition to considering the obstetrical setting, to combine transperineal ultrasound with transvaginal digital examination to avoid deleterious failure of operative vaginal delivery.
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Benediktsdottir S, Salvesen KÅ, Hjartardottir H, Eggebø TM. Reproducibility and acceptability of ultrasound measurements of head-perineum distance. Acta Obstet Gynecol Scand 2017; 97:97-103. [DOI: 10.1111/aogs.13251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/19/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Sigurlaug Benediktsdottir
- Department of Obstetrics and Gynecology; Clinical Sciences; Lund University; Lund Sweden
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | - Kjell Å. Salvesen
- Center for Fetal Medicine; Trondheim University Hospital (St Olavs Hospital); Trondheim Norway
- Institute of Clinical and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - Hulda Hjartardottir
- Department of Obstetrics and Gynecology; Landspitali University Hospital; Reykjavik Iceland
| | - Torbjørn M. Eggebø
- Center for Fetal Medicine; Trondheim University Hospital (St Olavs Hospital); Trondheim Norway
- Institute of Clinical and Molecular Medicine; Norwegian University of Science and Technology; Trondheim Norway
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Sainz JA, Fernández-Palacín A, Borrero C, Aquise A, Ramos Z, García-Mejido JA. Intra and interobserver variability of intrapartum transperineal ultrasound measurements with contraction and pushing. J OBSTET GYNAECOL 2017; 38:333-338. [DOI: 10.1080/01443615.2017.1354179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- José A. Sainz
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynaecology, University of Seville, Seville, Spain
| | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Carlota Borrero
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
| | - Adriana Aquise
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
| | - Zenaida Ramos
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain
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Salsi G, Cataneo I, Dodaro G, Rizzo N, Pilu G, Sanz Gascón M, Youssef A. Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects. Int J Womens Health 2017; 9:643-656. [PMID: 28979167 PMCID: PMC5602462 DOI: 10.2147/ijwh.s103789] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During the last decade, there has been a huge advancement in the use of transperineal ultrasound (TPU) in the field of obstetrics and gynecology. Its main applications in obstetrics include the monitoring of fetal progression in labor and recently the assessment of maternal pelvic dimensions, whereas in gynecology, TPU is at present widely used for the evaluation of the female pelvic floor, opening new boundaries for the assessment of pelvic floor disorders. The association of volumetric three-dimensional techniques has largely contributed to the remarkable progress that has occurred in the use of TPU. The aim of this paper is to offer an overview of the advantages, challenges and future perspectives of the use of TPU for women’s imaging.
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Affiliation(s)
- Ginevra Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Cataneo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Gaia Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Mar Sanz Gascón
- Department of Obstetrics and Gynecology, La Fé University Hospital, University of Valencia.,Prenatal Diagnosis Unit, Casa del Salud University Hospital, Valencia, Spain
| | - Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Yonetani N, Yamamoto R. Reply. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:664. [PMID: 28471027 DOI: 10.1002/uog.17425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- N Yonetani
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - R Yamamoto
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
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Montaguti E, Rizzo N, Pilu G, Youssef A. Automated 3D ultrasound measurement of the angle of progression in labor. J Matern Fetal Neonatal Med 2017; 31:141-149. [DOI: 10.1080/14767058.2016.1277701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elisa Montaguti
- Department of Obstetrics and Gynecology, Sant’Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Sant’Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Department of Obstetrics and Gynecology, Sant’Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Aly Youssef
- Department of Obstetrics and Gynecology, Sant’Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Armbrust R, Henrich W, Hinkson L, Grieser C, Siedentopf JP. Correlation of intrapartum translabial ultrasound parameters with computed tomographic 3D reconstruction of the female pelvis. J Perinat Med 2016; 44:567-71. [PMID: 26982609 DOI: 10.1515/jpm-2015-0395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/25/2016] [Indexed: 01/01/2023]
Abstract
AIMS Intrapartum translabial ultrasound [ITU] can be an objective, reproducible and more reliable method than digital vaginal examination when evaluating fetal head position and station in prolonged second stage of labor. However, two-dimensional (2D) ultrasound is not sufficient to demonstrate the ischial spines and other important "landmarks" of the female pelvis. Therefore, the purpose of this study was to evaluate the distance of the interspinous plane as a parallel line to the infrapubic line in 2D ITU with the help of 3D computed tomography and digital reconstruction. RESULTS Mean distance between the infrapubic plane and the tip of the ischiadic spine was 32.35 (±4.46) mm. The mean height was 166 (±7) cm; the mean weight was 67.5 (±18.4) kg. Body height and the measured distance were significantly correlated (P=0.025; correlation coefficient of 0.5), whereas body weight was not (P=0.37; correlation coefficient of -0.214). CONCLUSIONS With the present results, clinicians were enabled to transfer the reproducible measurements of the "head station" by ITU to the widespread but observer-depending vaginal examination. Furthermore, ITU can be verified as an objective method in comparison to subjective palpation with the ability to optimize the evaluation of the head station according to bony structures as landmarks in a standardized application.
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Kameyama S, Sato A, Miura H, Kumagai J, Sato N, Shimizu D, Makino K, Terada Y. Prediction of spontaneous vaginal delivery by transperineal ultrasound performed just after full cervical dilatation is determined. J Med Ultrason (2001) 2016; 43:243-8. [PMID: 27033869 DOI: 10.1007/s10396-015-0681-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate whether transperineal ultrasound examination just after full cervical dilatation is determined can predict the mode of delivery. METHODS This was a prospective observational study of pregnant women. After full cervical dilatation was determined by vaginal examination during labor, transperineal ultrasound was immediately performed, and the head direction (HD), progression distance (PD), and angle of progression (AoP) were measured. The cases were divided into two groups: spontaneous vaginal delivery and operative delivery due to failure of progression. Differences between the groups were statistically analyzed using Student's t test and Fisher's exact test. RESULTS Of the 50 women, 42 had spontaneous vaginal deliveries and 8 had vacuum extractions. The spontaneous delivery group had significantly higher HD, PD, and AoP values than the vacuum extraction group. The areas under the receiver-operating characteristic curves for the prediction of spontaneous vaginal delivery were 0.850 for HD, 0.827 for PD, and 0.783 for AoP. The optimum cut-off points and positive predictive values were 83° and 92.9 % for HD, 56 mm and 94.9 % for PD, and 146° and 94.3 % for AoP, respectively. CONCLUSION Transperineal ultrasound examination just after full cervical dilatation was determined was useful in predicting spontaneous vaginal delivery.
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Affiliation(s)
- Saeko Kameyama
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Akira Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Hiroshi Miura
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Jin Kumagai
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Dai Shimizu
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kenichi Makino
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Benediktsdottir S, Eggebø TM, Salvesen KÅ. Agreement between transperineal ultrasound measurements and digital examinations of cervical dilatation during labor. BMC Pregnancy Childbirth 2015; 15:273. [PMID: 26496894 PMCID: PMC4619348 DOI: 10.1186/s12884-015-0704-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022] Open
Abstract
Background To compare 2D transperineal ultrasound assessment of cervical dilatation with vaginal examination and to investigate intra-observer variability of the ultrasound method. Methods A prospective observational study was performed at Skane University Hospital, Lund, Sweden between October 2013 and June 2014. Women with one fetus in cephalic presentation at term had the cervical dilatation assessed with ultrasound and digital vaginal examinations during labor. Inter-method agreement between ultrasound and digital examinations and intra-observer repeatability of ultrasound examinations were tested. Results Cervical dilatation was successfully assessed with ultrasound in 61/86 (71 %) women. The mean difference between cervical dilatation and ultrasound measurement was 0.9 cm (95 % CI 0.47–1.34). Interclass correlation coefficient (ICC) was 0.83 (95 % CI 0.72–0.90). Intra-observer repeatability was analysed in 26 women. The intra-observer ICC was 0.99 (95 % CI 0.97–0.99). The repeatability coefficient was ± 0.68 (95 % CI 0.45–0.91). Conclusion The mean ultrasound measurement of cervical dilatation was approximately 1 cm less than clinical assessment. The intra-observer repeatability of ultrasound measurements was high.
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Affiliation(s)
| | - Torbjørn M Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway. .,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Kjell Å Salvesen
- Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden. .,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
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18
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Coelho Neto MA, Roncato P, Nastri CO, Martins WP. True Reproducibility of UltraSound Techniques (TRUST): systematic review of reliability studies in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:14-20. [PMID: 25175693 DOI: 10.1002/uog.14654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the quality of methods used and the accuracy of the interpretation of agreement in existing studies that examine the reliability of ultrasound measurements and judgments in obstetrics and gynecology. METHODS A systematic search of MEDLINE was performed on 25 March 2014, looking for studies that examined the reliability of ultrasound measurements and judgments in obstetrics and gynecology with evaluation of concordance (CCC) or intraclass (ICC) correlation coefficients or kappa as a main objective. RESULTS Seven hundred and thirty-three records were examined on the basis of their title and abstract, of which 141 full-text articles were examined completely for eligibility. We excluded 29 studies because they did not report CCC/ICC/kappa, leaving 112 studies that were included in our analysis. Two studies reported both ICC and kappa and were counted twice, therefore, the number used as the denominator in the analyses was 114. Only 16/114 (14.0%) studies were considered to be well designed (independent acquisition and blinded analysis) and to have interpreted the results properly. Most errors occurring in the studies are likely to overestimate the reliability of the method examined. CONCLUSIONS The vast majority of published studies examined had important flaws in design, interpretation and/or reporting. Such limitations are important to identify as they might create false confidence in the existing measurements and judgments, jeopardizing clinical practice and future research. Specific guidelines aimed at improving the quality of reproducibility studies that examine ultrasound methods should be encouraged.
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Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - P Roncato
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
- School of Health Technology - Ultrasonography School of Ribeirao Preto (FATESA-EURP), Ribeirao Preto, Brazil
| | - C O Nastri
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
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Affiliation(s)
- Sana Usman
- Imperial CollegeInstitute of Reproductive Developmental BiologyHammersmith CampusW12 0DN; Queen Charlottes and Chelsea HospitalImperial College Healthcare NHS TrustDu Cane RoadLondonW12 0HS
| | - Christoph Lees
- Imperial CollegeInstitute of Reproductive Developmental BiologyHammersmith CampusW12 0DN; Queen Charlottes and Chelsea HospitalImperial College Healthcare NHS TrustDu Cane RoadLondonW12 0HS
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20
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Patwardhan M, Hernandez-Andrade E, Ahn H, Korzeniewski SJ, Schwartz A, Hassan SS, Romero R. Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications. Gynecol Obstet Invest 2015; 80:26-37. [PMID: 25634647 PMCID: PMC4536955 DOI: 10.1159/000370001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate dynamic changes in myometrial thickness during the third stage of labor. METHODS Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated. RESULTS There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed. CONCLUSION A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage.
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Affiliation(s)
- Manasi Patwardhan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Hyunyoung Ahn
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Steven J Korzeniewski
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Alyse Schwartz
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan; USA
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Sainz JA, Borrero C, Fernández-Palacín A, Aquise A, Valdivieso P, Pastor L, Garrido R. Intrapartum transperineal ultrasound as a predictor of instrumentation difficulty with vacuum-assisted delivery in primiparous women. J Matern Fetal Neonatal Med 2014; 28:2041-7. [DOI: 10.3109/14767058.2014.976547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- José A. Sainz
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
- Department of Obstetrics and Gynaecology, University of Seville, Spain, and
| | - Carlota Borrero
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Ana Fernández-Palacín
- Department of Preventive Medicine and Public Health, Biostatistics Unit, University of Seville, Spain
| | - Adriana Aquise
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Pamela Valdivieso
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Luis Pastor
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
| | - Rogelio Garrido
- Department of Obstetrics and Gynaecology, Valme University Hospital, Seville, Spain,
- Department of Obstetrics and Gynaecology, University of Seville, Spain, and
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Chan YTV, Ng VKS, Yung WK, Lo TK, Leung WC, Lau WL. Relationship between intrapartum transperineal ultrasound measurement of angle of progression and head–perineum distance with correlation to conventional clinical parameters of labor progress and time to delivery. J Matern Fetal Neonatal Med 2014; 28:1476-81. [DOI: 10.3109/14767058.2014.958459] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Youssef A, Bellussi F, Montaguti E, Maroni E, Salsi G, Morselli-Labate AM, Paccapelo A, Rizzo N, Pilu G, Ghi T. Agreement between two- and three-dimensional transperineal ultrasound methods for assessment of fetal head-symphysis distance in active labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:183-188. [PMID: 24006290 DOI: 10.1002/uog.13204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/24/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the intermethod agreement between two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound methods in measuring a new index of fetal head station (the fetal head-symphysis distance (HSD)) in active labor, and to assess potential factors that may affect their agreement. METHODS HSD was measured by transperineal ultrasound in 86 women in active labor, once using a 2D and once using a 3D technique. 2D images were acquired first in 43 cases and 3D images were acquired first in the other 43 women. Intermethod agreement between 2D and 3D methods was analyzed by means of intraclass correlation coefficient (ICC) and Bland-Altman analysis. In addition, potential factors affecting the intermethod reproducibility were investigated including fetal occiput position, order of acquisition, fetal head station, stage of labor, maternal body mass index and use of epidural analgesia, using the ANOVA test to check for systematic bias and Levene's test for homoscedasticity. RESULTS Good agreement was demonstrated between 2D and 3D measurements of HSD (ICC, 0.949 (95% CI, 0.914-0.984)). No evidence of systematic difference was shown between the two methods (average difference ± SD = 0.03 ± 2.29 mm; P = 0.888). The only factor that had a significant effect on systematic difference between 2D and 3D methods was order of acquisition (P = 0.042); the first observation was higher regardless of the method used. Fetal head station had a significant effect on the homogeneity between the two methods (P = 0.004) with a better 2D-3D agreement obtained at lower head stations (SD of differences: 1.63 vs 2.59 mm). CONCLUSIONS There is very good agreement between 2D and 3D methods of assessing HSD. Agreement is better in lower fetal head stations.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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Eggebø TM, Hassan WA, Salvesen KÅ, Lindtjørn E, Lees CC. Sonographic prediction of vaginal delivery in prolonged labor: a two-center study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:195-201. [PMID: 24105705 DOI: 10.1002/uog.13210] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/03/2013] [Accepted: 09/06/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). METHODS This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. RESULTS Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was ≤ 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was > 40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was ≥ 110° in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was < 110° in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD ≤ 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP ≥ 110° (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. CONCLUSION Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor.
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Affiliation(s)
- T M Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
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25
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Hassan WA, Eggebø T, Ferguson M, Gillett A, Studd J, Pasupathy D, Lees CC. The sonopartogram: a novel method for recording progress of labor by ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:189-194. [PMID: 24105734 DOI: 10.1002/uog.13212] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Progress of labor has hitherto been assessed by digital vaginal examination (VE). We introduce the concept of a non-intrusive ultrasound (US)-based assessment of labor progress (the 'sonopartogram') and investigate its feasibility for assessing cervical dilatation and fetal head descent and rotation. METHODS This was a prospective study performed in 20 women in the first stage of labor in two European maternity units. Almost simultaneous assessment of cervical dilatation and fetal head descent and rotation were made by US and digital VE. RESULTS The total number of paired US and digital VE assessments was 52, with a median of three per woman. Overall, 5% of sonopartogram parameters were not obtained compared with 18% of conventional digital VE parameters (P < 0.001). Assessment of cervical dilatation was possible in 86.5% of US examinations and 100% of digital VEs (P = 0.02), and dilatation was assessed as being greater by digital VE than by US (mean difference, 1.16 (95% limits of agreement, -0.76, 3.08) cm, r(2) = 0.68, P = 0.01). Fetal head descent was measured in all 52 cases by both methods (r(2) = 0.33, P < 0.001), but correlation between the two was only moderate. Head rotation was obtainable in 98% of US examinations and 46% of digital VEs (P < 0.001), with a mean difference of -3.9° (95% limits of agreement, -144.1°, 136.3°). CONCLUSION In this proof-of-concept study, the acquisition of data regarding progress of labor was more successful for the sonopartogram than the conventional partogram. The agreement between digital VE and US was good for cervical dilatation and head rotation but less so for head descent. US assessment of the progress of labor is feasible in most cases.
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Affiliation(s)
- W A Hassan
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ghi T, Youssef A, Maroni E, Arcangeli T, De Musso F, Bellussi F, Nanni M, Giorgetta F, Morselli-Labate AM, Iammarino MT, Paccapelo A, Cariello L, Rizzo N, Pilu G. Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:430-435. [PMID: 23288706 DOI: 10.1002/uog.12379] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery. METHODS A three-dimensional transperineal ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5 and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. RESULTS Among 71 women included in the study, 58 underwent spontaneous vaginal delivery (group A) and 13 underwent operative delivery (group B) (eight by vacuum extraction and five by Cesarean section). When compared with Group B, Group A had a wider AoP only at T1 (140.0 ± 20.2° vs. 122.9 ± 16.7°; P = 0.010) and T2 (149.7 ± 20.7° vs. 126.9 ± 17.5°; P = 0.006). MLA was narrower in group A only at T3 (21.2 ± 11.7° vs. 40.8 ± 27.9°; P = 0.043), T4 (18.2 ± 15.0° vs. 47.4 ± 29.6°; P = 0.020) and T5 (18.3 ± 6.0° vs. 34.7 ± 4.2°; P = 0.034). On stepwise forward multiple logistic regression analysis, both AoP and MLA were independently associated with operative delivery (OR = 0.955 and OR = 1.018, respectively). CONCLUSION Ultrasonographic assessment of fetal head descent in the second stage of labor may play a role in the prediction of the mode of delivery.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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Eggebø TM. Ultrasound is the future diagnostic tool in active labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:361-363. [PMID: 23641509 DOI: 10.1002/uog.12417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- T M Eggebø
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
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Tutschek B, Torkildsen EA, Eggebø TM. Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:425-429. [PMID: 23371409 DOI: 10.1002/uog.12422] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Several ultrasound parameters, including intrapartum transperineal ultrasound (ITU) head station, angle of progression (AOP), head-perineum distance (HPD) and head-symphysis distance (HSD), have been suggested to assess fetal head station during labor. The aim of this study was to analyze the relationship between these ultrasound parameters and to compare them with digital palpation. METHODS We analyzed 106 stored volume dataset pairs that had been acquired at Stavanger University Hospital, Norway, from nulliparous women at term with prolonged first stage of labor. The volumes were acquired using a three-dimensional transducer applied between the labia majora in a mid-sagittal plane and perineally in a transverse plane. Digitally palpated head station and cervical dilatation were also noted. The results were compared using regression and correlation coefficients. RESULTS There were good correlations between ITU head station and HPD (r = 0.71), between ITU head station and HSD (r = 0.74) and between HSD and HPD (r = 0.75). Palpated head station showed only moderate correlation with ITU head station (r = 0.52). Cervical dilatation showed a weak correlation with ITU head station (r = 0.30). CONCLUSION The ultrasound parameters showed a high degree of correlation with each other, but only moderate correlation to vaginally palpated fetal head station.
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Affiliation(s)
- B Tutschek
- Heinrich Heine University, Düsseldorf, Germany.
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Youssef A, Maroni E, Ragusa A, De Musso F, Salsi G, Iammarino MT, Paccapelo A, Rizzo N, Pilu G, Ghi T. Fetal head-symphysis distance: a simple and reliable ultrasound index of fetal head station in labor. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:419-424. [PMID: 23124698 DOI: 10.1002/uog.12335] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To assess the reproducibility of measurement of a new sonographic index of fetal head station in labor, the fetal head-symphysis distance (HSD), using three-dimensional ultrasound, and its correlation with digital assessment of fetal head descent and with the angle of progression (AoP). METHODS Three-dimensional (3D) ultrasound volumes were acquired from 47 nulliparous women in active labor following assessment of fetal head station with digital examination. The HSD (the distance between the lower edge of the pubic symphysis and the nearest point of the fetal skull) was measured independently by two operators in order to evaluate intra- and interobserver reproducibility. The correlation between HSD, AoP and fetal head station was evaluated using regression analysis. Using 3D tomographic ultrasound imaging (TUI), measurements of the HSD were obtained in different parasagittal planes to evaluate the influence of inaccurate alignment of the probe with the midline of the pelvis. RESULTS Measurement of HSD showed high intraobserver (intraclass correlation coefficient (ICC) = 0.995; 95% CI, 0.991-0.997) and interobserver (ICC = 0.991; 95% CI, 0.984-0.995) reliability. In addition, a high correlation was demonstrated between mid-sagittal and parasagittal HSD measurements. HSD showed significant negative correlation with both fetal head station and AoP. CONCLUSION Fetal HSD is a simple and reliable method for the assessment of fetal head descent in labor.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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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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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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