1
|
Ramirez Zegarra R, Dall'Asta A, di Pasquo E, Ghi T. Antepartum sonographic prediction of cephalopelvic disproportion: are we getting any closer? Am J Obstet Gynecol MFM 2023; 5:100828. [PMID: 36529655 DOI: 10.1016/j.ajogmf.2022.100828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/15/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Ruben Ramirez Zegarra
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Dall'Asta
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elvira di Pasquo
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tullio Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| |
Collapse
|
2
|
Perlman S, Schreiber H, Kivilevitch Z, Bardin R, Kassif E, Achiron R, Gilboa Y. Sonographic risk assessment for an unplanned operative delivery: a prospective study. Arch Gynecol Obstet 2022; 306:1469-1475. [PMID: 35107615 DOI: 10.1007/s00404-022-06413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery. METHODS In this prospective study, nulliparous women were recruited at 37.0-42.0 weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD. RESULTS Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118. CONCLUSION Sonographic parameters representing maternal pelvic configuration (PAA) and maternal-fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.
Collapse
Affiliation(s)
- Sharon Perlman
- Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Zeev Jabotinsky Rd 39, 49100, Petah Tikva, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Hanoch Schreiber
- Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Zeev Jabotinsky Rd 39, 49100, Petah Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Kivilevitch
- Ultrasound Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel
| | - Ron Bardin
- Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Zeev Jabotinsky Rd 39, 49100, Petah Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Kassif
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel
| | - Reuven Achiron
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Ultrasound Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel
| | - Yinon Gilboa
- Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Zeev Jabotinsky Rd 39, 49100, Petah Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Di Pasquo E, Volpe N, Labadini C, Morganelli G, Di Tonto A, Schera GBL, Rizzo G, Frusca T, Ghi T. Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study. Acta Obstet Gynecol Scand 2021; 100:1917-1923. [PMID: 34240404 DOI: 10.1111/aogs.14226] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. MATERIAL AND METHODS This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. CONCLUSIONS Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.
Collapse
Affiliation(s)
- Elvira Di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - Corinne Labadini
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giovanni Morganelli
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Andrea Di Tonto
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giovanni B L Schera
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Fetal Medicine, "Cristo Re" Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Tiziana Frusca
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Surgical Sciences, University of Parma, Parma, Italy
| |
Collapse
|
4
|
Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study. Acta Obstet Gynecol Scand 2021. [DOI: org/10.1111/aogs.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
The role of the angle of progression in the prediction of the outcome of occiput posterior position in the second stage of labor. Am J Obstet Gynecol 2021; 225:81.e1-81.e9. [PMID: 33508312 DOI: 10.1016/j.ajog.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Occiput posterior position is the most frequent cephalic malposition, and its persistence at delivery is associated with a higher risk of maternal and perinatal morbidity. Diagnosis and management of occiput posterior position remain a clinical challenge. This is partly caused by our inability to predict fetuses who will spontaneously rotate into occiput anterior from those who will have persistent occiput posterior position. The angle of progression, measured with transperineal ultrasound, represents a reliable tool for the evaluation of fetal head station during labor. The relationship between the persistence of occiput posterior position and fetal head station in the second stage of labor has not been previously assessed. OBJECTIVE This study aimed to evaluate the role of fetal head station, as measured by the angle of progression, in the prediction of persistent occiput posterior position and the mode of delivery in the second stage of labor. STUDY DESIGN We recruited a nonconsecutive series of women with posterior occiput position diagnosed by transabdominal ultrasound in the second stage of labor. For each woman, a transperineal ultrasound was performed to measure the angle of progression at rest. We compared the angle of progression between women who delivered fetuses in occiput anterior position and those with persistent occiput posterior position at delivery. Receiver operating characteristics curves were performed to evaluate the accuracy of the angle of progression in the prediction of persistent occiput posterior position. Finally, we performed a multivariate logistic regression to determine independent predictors of persistent occiput posterior position. RESULTS Overall, 63 women were included in the analysis. Among these, 39 women (62%) delivered in occiput anterior position, whereas 24 (38%) delivered in occiput posterior position (persistent occiput posterior position). The angle of progression was significantly narrower in the persistent occiput posterior position group than in women who delivered fetuses in occiput anterior position (118.3°±12.2° vs 127.5°±10.5°; P=.003). The area under the receiver operating characteristics curve was 0.731 (95% confidence interval, 0.594-0.869) with an estimated best cutoff range of 121.5° (sensitivity of 72% and specificity of 67%). On logistic regression analysis, the angle of progression was found to be independently associated with persistence of occiput posterior position (odds ratio, 0.942; 95% confidence interval, 0.889-0.998; P=.04). Finally, women who underwent cesarean delivery had significantly narrower angle of progression than women who had a vaginal delivery (113.5°±8.1 vs 128.0°±10.7; P<.001). The area under the receiver operating characteristics curve for the prediction of cesarean delivery was 0.866 (95% confidence interval, 0.761-0.972). At multivariable logistic regression analysis including the angle of progression, parity, and gestational age at delivery, the angle of progression was found to be the only independent predictor associated with cesarean delivery (odds ratio, 0.849; 95% confidence interval, 0.775-0.0930; P<.001). CONCLUSION In fetuses with occiput posterior at the beginning of the second stage of labor, narrower values of the angle of progression are associated with higher rates of persistent occiput posterior position at delivery and a higher risk of cesarean delivery.
Collapse
|
6
|
Kamel R, Garcia FSM, Poon LC, Youssef A. The usefulness of ultrasound before induction of labor. Am J Obstet Gynecol MFM 2021; 3:100423. [PMID: 34129996 DOI: 10.1016/j.ajogmf.2021.100423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
The indications for induction of labor have been consistently on the rise. These indications are mainly medical (maternal or fetal) or social or related to convenience or maternal preferences. With the increase in the prevalence of these indications, the incidence rates of induction of labor are expected to rise continuously. This poses a substantial workload and financial burden on maternity healthcare systems. Failure rates of induction of labor are relatively high, especially when considering the maternal, fetal, and neonatal risks associated with emergency cesarean deliveries in cases of failure. Therefore, it is essential for obstetricians to carefully select women who are eligible for induction of labor, particularly those with no clinical contraindication and who have a reasonable chance of ending up with a successful noncomplicated vaginal delivery. Ultrasound has an established role in the various areas of obstetrical care. It is available, accessible, easy to perform, and acceptable to the patient. In addition, the learning curve for skillful obstetrical ultrasound scanning is rather easy to fulfill. Ultrasound has always had an important role in the assessment of maternal and fetal well-being. Indeed, it has been extensively explored as a reliable, reproducible, and objective tool in the management of labor. In this review, we aimed to provide a comprehensive update on the different applications and uses of ultrasound before induction of labor for the prediction of its success and the potential improvement of its health-related maternal and fetal outcomes.
Collapse
Affiliation(s)
- Rasha Kamel
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt (Dr Kamel).
| | - Francisca S Molina Garcia
- Department of Obstetrics and Gynecology, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria IBS, Granada, Spain (Dr Molina Garcia)
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China (Dr Poon)
| | - Aly Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy (Dr Youssef)
| |
Collapse
|
7
|
Perlman S, Raviv-Zilka L, Levinsky D, Gidron A, Achiron R, Gilboa Y, Kivilevitch Z. The birth canal: correlation between the pubic arch angle, the interspinous diameter, and the obstetrical conjugate: a computed tomography biometric study in reproductive age women. J Matern Fetal Neonatal Med 2018; 32:3255-3265. [DOI: 10.1080/14767058.2018.1462322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Raviv-Zilka
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Safra Children’s Hospital, the Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Denis Levinsky
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Ayelet Gidron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Rizzo G, Aiello E, Bosi C, D'Antonio F, Arduini D. Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand 2017; 96:1006-1011. [PMID: 28449356 DOI: 10.1111/aogs.13162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/20/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this study was to ascertain whether combined ultrasound assessment of fetal head circumference (HC) and maternal subpubic angle (SPA) prior to the onset of labor may predict the likelihood of an unplanned operative delivery (UOD) in nulliparous women at term. MATERIAL AND METHODS Prospective cohort study of singleton pregnancies in cephalic presentation. Pregnancies experiencing UOD secondary to fetal distress were excluded. HC was assessed transabdominally and SPA values were obtained from a reconstructed coronal plane on three-dimensional (3D) ultrasound performed translabially at 36-38 weeks of gestation. Maternal characteristics, HC expressed as multiple of median, and SPA were compared according to the mode of delivery. Logistic regression and receiver operating characteristics curve analyses were used to analyze the data. RESULTS 597 pregnancies were included in the study. Spontaneous vaginal delivery occurred in 70.2% of the cases and UOD was required in 29.8%. There was no difference in pregnancy characteristics and birthweight between women who had a spontaneous vaginal birth compared with UOD. The HC multiple of median was larger (1.00 ± 0.02 vs. 1.03 ± 0.02, p ≤ 0.0001), whereas SPA was narrower in the UOD group (124.02 ± 13.64 vs. 102.61 ± 16.13, p ≤ 0.0001). At logistic regression, SPA (OR 0.91, 95% CI 0.89-0.93), HC multiple of median (OR 1.13, 95% CI 1.09-1.17) and maternal height (OR 0.95, 95% CI 0.92-0.99) were independently associated with UOD. When combined, the diagnostic accuracy of a predictive model integrating HC, SPA and maternal height was highly predictive of UOD with an area under the curve of 0.904 (95% CI 0.88-0.93). CONCLUSIONS Ultrasound assessment of fetal HC and maternal SPA after 36 weeks of gestation can identify a subset of women at higher risk of UOD during labor, for whom early planned delivery might be beneficial.
Collapse
Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Aiello
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - Costanza Bosi
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - Francesco D'Antonio
- Women's and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, UiT The Arctic University of Norway, Tromsø, Norway
| | - Domenico Arduini
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
10
|
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
| |
Collapse
|
11
|
Ghi T, Youssef A, Martelli F, Bellussi F, Aiello E, Pilu G, Rizzo N, Frusca T, Arduini D, Rizzo G. Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:511-515. [PMID: 26565728 DOI: 10.1002/uog.15808] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal occiput position at delivery and the mode of delivery. METHODS Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal occiput position at delivery and the incidence of operative delivery were investigated. RESULTS Overall, 368 women were included in the study. Fetal position at delivery was occiput anterior in 339 (92.1%) cases and occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°. CONCLUSION A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- T Ghi
- Department of Obstetrics, University of Parma, Parma, Italy.
| | - A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - F Martelli
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Aiello
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - T Frusca
- Department of Obstetrics, University of Parma, Parma, Italy
| | - D Arduini
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| |
Collapse
|
12
|
Youssef A, Salsi G, Cataneo I, Martelli F, Azzarone C, Bellussi F, Ghi T, Pilu G, Rizzo N. Agreement between two 3D ultrasound techniques for the assessment of the subpubic arch angle. J Matern Fetal Neonatal Med 2016; 30:1-5. [PMID: 27050886 DOI: 10.1080/14767058.2016.1175000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the reliability of a new three-dimensional (3D) ultrasound technique for the measurement of the subpubic arch angle (SPA) and the agreement between two contrast-enhancing 3D ultrasound techniques. METHODS We acquired two static 3D transperineal volumes from 72 nulliparous women using two ultrasound machines equipped with two different 3D contrast enhancement and linear reconstruction softwares: 1. Oblique View Extended Imaging with HD-Volume Imaging (OVIX-HDVI™), Samsung; 2. Omniview with Volume Contrast Imaging (Omniview-VCI™), GE Healthcare. An operator measured SPA once by OVIX-HDVI, and twice by Omniview-VCI, while another operator measured SPA once by Omniview-VCI. We evaluated intra- and inter-observer reproducibility of Omniview-VCI and intermethod agreement. Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficient (ICC) and Bland-Altman method. RESULTS Omniview-VCI SPA measurements showed excellent intraobserver and interobserver reproducibility (ICC 0.970; 95% C.I. 0.952 to 0.981, 0.932; 95% C.I. 0.893 to 0.957, respectively). Furthermore, Omniview VCI SPA measurements demonstrated excellent agreement with those performed by OVIX-HDVI technique (ICC 0.943; 95 C.I. 0.911 to 0.964). No systematic difference was found in any of the reliability studies. CONCLUSIONS OmniView-VCI is a reliable method for SPA assessment. Both OmniView-VCI and OVIX-HDVI can be used interchangeably for SPA measurement.
Collapse
Affiliation(s)
- Aly Youssef
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Ginevra Salsi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Ilaria Cataneo
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Federica Martelli
- b Department of Obstetrics and Gynecology , Tor Vergata University , Rome , Italy , and
| | - Carlotta Azzarone
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Federica Bellussi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Tullio Ghi
- c Department of Obstetrics and Gynecology , University of Parma , Parma , Italy
| | - Gianluigi Pilu
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Nicola Rizzo
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| |
Collapse
|
13
|
Youssef A, Ghi T, Martelli F, Montaguti E, Salsi G, Bellussi F, Pilu G, Rizzo N. Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women. Fetal Diagn Ther 2015; 40:150-5. [DOI: 10.1159/000441517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022]
Abstract
Objective: To assess whether subpubic arch angle (SPA) measurement before labor onset can predict labor outcome among low-risk pregnant women. Methods: 3D ultrasound volume was transperineally acquired from a series of nulliparous women with uncomplicated pregnancy at term before the onset of labor. SPA was measured offline using Oblique View Extended Imaging (OVIX) on each volume performed by an investigator not involved in the clinical management. Labor outcome was prospectively investigated in the whole study group. Results: Overall, 145 women were enrolled in the study. Of these, 83 underwent spontaneous vaginal delivery, whereas obstetric intervention was performed in 62 cases (Cesarean section in 40 and vacuum extraction in 22). The SPA appeared to be significantly narrower in the women submitted to obstetric intervention compared with those undergoing spontaneous vaginal delivery (116.8 ± 10.3° vs. 123.7 ± 9.6°, p < 0.01). At multivariate analysis SPA and maternal age were identified as independent predictors of the mode of delivery. On the other hand, the duration of labor did not show a significant relationship with SPA. Conclusions: In low-risk nulliparous women at term gestation, SPA measurement obtained by 3D ultrasound before the onset of labor seems to predict the likelihood of an obstetric intervention but not the duration of labor.
Collapse
|