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Eggebø TM, Hjartardottir H. Descent of the presenting part assessed with ultrasound. Am J Obstet Gynecol 2024; 230:S901-S912. [PMID: 34461079 DOI: 10.1016/j.ajog.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
Fetal head descent can be expressed as fetal station and engagement. Station is traditionally based on clinical vaginal examination of the distal part of the fetal skull and related to the level of the ischial spines. Engagement is based on a transabdominal examination of the proximal part of the fetal head above the pelvic inlet. Clinical examinations are subjective, and objective measurements of descent are warranted. Ultrasound is a feasible diagnostic tool in labor, and fetal lie, station, position, presentation, and attitude can be examined. This review presents an overview of fetal descent examined with ultrasound. Ultrasound was first introduced for examining fetal descent in 1977. The distance from the sacral tip to the fetal skull was measured with A-mode ultrasound, but more convenient transperineal methods have since been published. Of those, progression distance, angle of progression, and head-symphysis distance are examined in the sagittal plane, using the inferior part of the symphysis pubis as reference point. Head-perineum distance is measured in the frontal plane (transverse transperineal scan) as the shortest distance from perineum to the fetal skull, representing the remaining part of the birth canal for the fetus to pass. At high stations, the fetal head is directed downward, followed with a horizontal and then an upward direction when the fetus descends in the birth canal and deflexes the head. Head descent may be assessed transabdominally with ultrasound and measured as the suprapubic descent angle. Many observational studies have shown that fetal descent assessed with ultrasound can predict labor outcome before induction of labor, as an admission test, and during the first and second stage of labor. Labor progress can also be examined longitudinally. The International Society of Ultrasound in Obstetrics and Gynecology recommends using ultrasound in women with prolonged or arrested first or second stage of labor, when malpositions or malpresentations are suspected, and before an operative vaginal delivery. One single ultrasound parameter cannot tell for sure whether an instrumental delivery is going to be successful. Information about station and position is a prerequisite, but head direction, presentation, and attitude also should be considered.
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Affiliation(s)
- Torbjørn M Eggebø
- National Center for Fetal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Obstetrics and Gynecology, Helse Stavanger, Stavanger University Hospital, Stavanger, Norway.
| | - Hulda Hjartardottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Youssef A, Brunelli E, Fiorentini M, Pilu G, Spelzini F. Soft-tissue dystocia due to paradoxical contraction of the levator ani as a cause of prolonged second stage: concept, diagnosis, and potential treatment. Am J Obstet Gynecol 2024; 230:S856-S864. [PMID: 38462259 DOI: 10.1016/j.ajog.2022.12.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 03/12/2024]
Abstract
Smaller pelvic floor dimensions seem to have been an evolutionary need to provide adequate support for the pelvic organs and the fetal head. Pelvic floor dimension and shape contributed to the complexity of human birth. Maternal pushing associated with pelvic floor muscle relaxation is key to vaginal birth. Using transperineal ultrasound, pelvic floor dimensions can be objectively measured in both static and dynamic conditions, such as pelvic floor muscle contraction and pushing. Several studies have evaluated the role of the pelvic floor in labor outcomes. Smaller levator hiatal dimensions seem to be associated with a longer duration of the second stage of labor and a higher risk of cesarean and operative deliveries. Furthermore, smaller levator hiatal dimensions are associated with a higher fetal head station at term of pregnancy, as assessed by transperineal ultrasound. With maternal pushing, most women can relax their pelvic floor, thus increasing their pelvic floor dimensions. Some women contract rather than relax their pelvic floor muscles under pushing, which is associated with a reduction in the anteroposterior diameter of the levator hiatus. This phenomenon is called levator ani muscle coactivation. Coactivation in nulliparous women at term of pregnancy before the onset of labor is associated with a higher fetal head station at term of pregnancy and a longer duration of the second stage of labor. In addition, levator ani muscle coactivation in nulliparous women undergoing induction of labor is associated with a longer duration of the active second stage of labor. Whether we can improve maternal pelvic floor relaxation with consequent improvement in labor outcomes remains a matter of debate. Maternal education, physiotherapy, and visual feedback are promising interventions. In particular, ultrasound visual feedback before the onset of labor can help women increase their levator hiatal dimensions and correct levator ani muscle coactivation in some cases. Ultrasound visual feedback in the second stage of labor was found to help women push more efficiently, thus obtaining a lower fetal head station at ultrasound and a shorter duration of the second stage of labor. The available evidence on the role of any intervention aimed to aid women to better relax their pelvic floor remains limited, and more studies are needed before considering its routine clinical application.
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Affiliation(s)
- Aly Youssef
- Obstetric and Prenatal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy.
| | - Elena Brunelli
- Obstetric and Prenatal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Marta Fiorentini
- Obstetric and Prenatal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric and Prenatal Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Federico Spelzini
- Azienda Unità Sanitaria Locale della Romagna, Infermi Hospital, Rimini, Italy
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Preuss E, De Porto A, Zisman I, Bason H, Ron-Tal O, Tovbin J, Barzilay E. Visual biofeedback for shortening second stage of labor: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:9-14. [PMID: 37470679 DOI: 10.1002/uog.26314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To determine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery. METHODS This was a single-center randomized controlled trial. Nulliparous women under epidural anesthesia were randomized at the point of full dilation into the biofeedback group (n = 50) or the control group (n = 50). Both groups received coached maternal pushing during four consecutive contractions, while an experienced obstetrician performed transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing, before and during the first and fourth contractions. Second-stage duration and delivery outcomes were compared between groups. RESULTS Visual biofeedback did not affect the duration of the second stage, which lasted for a median of 2.28 (interquartile range (IQR), 1.25-3.10) h in the biofeedback group vs 2.08 (IQR, 1.58-3.02) h in the control group (P = 0.981). AOP was significantly higher in the biofeedback group compared with the control group, both at rest before the fourth contraction (mean ± SD, 142.6° ± 15.9° vs 136.8° ± 13.1°; P = 0.049) and while pushing during the fourth contraction (mean ± SD, 159.3° ± 19.2° vs 149.4° ± 15.1°; P = 0.005). The increase in AOP was significantly higher in the biofeedback compared with the control group between rest and pushing at the last push (mean ± SD, 16.6° ± 11.0° vs 12.6° ± 8.3°; P = 0.041) and between the first rest and last push (mean ± SD, 24.4° ± 13.6° vs 17.9° ± 11.3°; P = 0.011). The rate of intact perineum was similar between groups (12% vs 8%; P = 0.505). CONCLUSIONS Visual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second-stage duration, possibly due to the short duration of the intervention. Future studies should focus on continuous intervention throughout the second stage of labor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Preuss
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A De Porto
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - I Zisman
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - H Bason
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - O Ron-Tal
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - J Tovbin
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - E Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Jaufuraully S, Dromey B, Story L, David AL, Attilakos G, Siassakos D. Magnetic resonance imaging in late pregnancy to improve labour and delivery outcomes - a systematic literature review. BMC Pregnancy Childbirth 2022; 22:949. [PMID: 36536322 PMCID: PMC9761997 DOI: 10.1186/s12884-022-05290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) provides excellent soft tissue visualisation which may be useful in late pregnancy to predict labour outcome and maternal/neonatal birth trauma. OBJECTIVE To study if MRI in late pregnancy can predict maternal and neonatal outcomes of labour and birth. METHODS Systematic review of studies that performed MRI in late pregnancy or immediately postpartum. Studies were included if they imaged maternal pelvic or neonatal structures and assessed birth outcome. Meta-analysis was not performed due to the heterogeneity of studies. RESULTS Eighteen studies were selected. Twelve studies explored the value of MRI pelvimetry measurement and its utility to predict cephalopelvic disproportion (CPD) and vaginal breech birth. Four explored cervical imaging in predicting time interval to birth. Two imaged women in active labour and assessed mouldability of the fetal skull. No marker of CPD had both high sensitivity and specificity for predicting labour outcome. The fetal pelvic index yielded sensitivities between 59 and 60%, and specificities between 34 to 64%. Similarly, although the sensitivity of the cephalopelvic disproportion index in predicting labour outcome was high (85%), specificity was only 56%. In women with breech presentation, MRI was demonstrated to reduce the rates of emergency caesarean section from 35 to 19%, and allowed better selection of vaginal breech birth. Live birth studies showed that the fetal head undergoes a substantial degree of moulding and deformation during cephalic vaginal birth, which is not considered during pelvimetry. There are conflicting studies on the role of MRI in cervical imaging and predicting time interval to birth. CONCLUSION MRI is a promising imaging modality to assess aspects of CPD, yet no current marker of CPD accurately predicts labour outcome. With advances in MRI, it is hoped that novel methods can be developed to better identify individuals at risk of obstructed or pathological labour. Its role in exploring fetal head moulding as a marker of CPD should be further explored.
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Affiliation(s)
- Shireen Jaufuraully
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Brian Dromey
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Lisa Story
- grid.13097.3c0000 0001 2322 6764Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK ,grid.425213.3Fetal Medicine Unit, St Thomas’ Hospital, London, UK
| | - Anna L David
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC), 149 Tottenham Court Road, London, UK
| | - George Attilakos
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Dimitrios Siassakos
- grid.83440.3b0000000121901201Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK ,grid.83440.3b0000000121901201Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK ,grid.451056.30000 0001 2116 3923National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre (BRC), 149 Tottenham Court Road, London, UK
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Yano E, Iriyama T, Hanaoka S, Sayama S, Ichinose M, Toshimitsu M, Seyama T, Sone K, Kumasawa K, Nagamatsu T, Kobayashi K, Fujii T, Osuga Y. Anatomical identification of ischial spines applicable to intrapartum transperineal ultrasound based on magnetic resonance imaging of pregnant women. J Matern Fetal Neonatal Med 2022; 35:9736-9741. [PMID: 35287536 DOI: 10.1080/14767058.2022.2051007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Intrapartum transperineal ultrasound is considered useful in judging fetal head descent; however, the inability to detect ischial spines on ultrasound images has been a drawback to its legitimacy. The current study aimed to determine the anatomical location of ischial spines, which can be directly applied to intrapartum transperineal ultrasound images. METHOD Based on magnetic resonance imaging (MRI) of 67 pregnant women at 33+2 [31+6-34+0] weeks gestation (median [interquartile range: IQR]), we calculated the angle between the pubic symphysis and the midpoint of ischial spines (midline symphysis-ischial spine angle; mSIA), which is theoretically equivalent to the angle of progression at fetal head station 0 on ITU, by determining spatial coordinates of pelvic landmarks and utilizing spatial vector analysis. Furthermore, we measured symphysis-ischial spine distance (SID), defined as the distance between the vertical plane passing the lower edge of the pubic symphysis and the plane that passes the ischial spines. RESULTS As a result, mSIA was 109.6° [105.1-114.0] and SID 26.4 mm [19.8-30.7] (median, [IQR]). There was no correlation between mSIA or SID and maternal characteristics, including physique. CONCLUSIONS We established a novel method to measure the components of the pelvic anatomy by analyzing the three-dimensional coordinates of MRI data and identified the anatomical location of ischial spines which can be applied to ultrasound images. Our results provide valuable evidence to enhance the reliability of intrapartum transperineal ultrasound in assessing fetal head descent by considering the location of ischial spines.
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Affiliation(s)
- Eriko Yano
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shouhei Hanaoka
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mari Ichinose
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatake Toshimitsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Seyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Kobayashi
- Department of Obstetrics and Gynecology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Sanno Hospital, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Rizzo G, Ghi T, Henrich W, Tutschek B, Kamel R, Lees CC, Mappa I, Kovalenko M, Lau W, Eggebo T, Achiron R, Sen C. Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation. J Perinat Med 2022; 50:1007-1029. [PMID: 35618672 DOI: 10.1515/jpm-2022-0160] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022]
Abstract
This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- UOC Ostetricia e Ginecologia Azienda Ospedaliera Universitaria di Parma, Parma, Italy
- Della Scuola di Specializzazione in Ostetricia e Ginecologia Presidente del CdS Ostetricia, Parma, Italy
| | - Wolfgang Henrich
- Department of Obstetrics, University Medical Center Berlin, Charité, Berlin, Germany
| | - Boris Tutschek
- Specialist in Gynecology and Obstetrics FMH, Focus Obstetrics and Feto-Maternal Medicine, Zurich, Switzerland
| | - Rasha Kamel
- Department of Obstetrics and Gynecology Maternal-Fetal medicine unit, Cairo University, Cairo, Egypt
| | - Christoph C Lees
- Imperial College London and Head of Fetal Medicine, Imperial College Healthcare NHS Trust, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Ilenia Mappa
- Università di Roma Tor Vergata, Unità Operativa di Medicina Materno Fetale Ospedale Cristo Re Roma, Rome, Italy
| | | | - Wailam Lau
- Department of O&G, Kwong Wah Hospital, Hong Kong SAR, China
| | - Torbjorn Eggebo
- National center for fetal medicine, St.Olavs Hospital, Trondheim, Norway
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Ultrasound unit, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Ramat-Gan, Israel
| | - Cihat Sen
- Perinatal Medicine Foundation, Istanbul, Turkey
- Department of Perinatal Medicine, Memorial BAH Hospital, Istanbul, Turkey
- Department of Perinatal Medicine, Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Multitask Deep Neural Network for the Fully Automatic Measurement of the Angle of Progression. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5192338. [PMID: 36092792 PMCID: PMC9462992 DOI: 10.1155/2022/5192338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022]
Abstract
The angle of progression (AoP) for assessing fetal head (FH) descent during labor is measured from the standard plane of transperineal ultrasound images as the angle between a line through the long axis of pubic symphysis (PS) and a second line from the right end of PS tangentially to the contour of the FH. This paper presents a multitask network with a shared feature encoder and three task-special decoders for standard plane recognition (Task1), image segmentation (Task2) of PS and FH, and endpoint detection (Task3) of PS. Based on the segmented FH and two endpoints of PS from standard plane images, we determined the right FH tangent point that passes through the right endpoint of PS and then computed the AoP using the above three points. In this paper, the efficient channel attention unit is introduced into the shared feature encoder for improving the robustness of layer region encoding, while an attention fusion module is used to promote cross-branch interaction between the encoder for Task2 and that for Task3, and a shape-constrained loss function is designed for enhancing the robustness to noise based on the convex shape-prior. We use Pearson's correlation coefficient and the Bland–Altman graph to assess the degree of agreement. The dataset includes 1964 images, where 919 images are nonstandard planes, and the other 1045 images are standard planes including PS and FH. We achieve a classification accuracy of 92.26%, and for the AoP calculation, an absolute mean (STD) value of the difference in AoP (∆AoP) is 3.898° (3.192°), the Pearson's correlation coefficient between manual and automated AoP was 0.964 and the Bland-Altman plot demonstrates they were statistically significant (P < 0.05). In conclusion, our approach can achieve a fully automatic measurement of AoP with good efficiency and may help labor progress in the future.
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Haumonte JB, Blanc J, Castel P, Mace P, Auquier P, d’Ercole C, Bretelle F. Uncertain fetal head engagement: a prospective randomized controlled trial comparing digital exam with angle of progression. Am J Obstet Gynecol 2022; 227:625.e1-625.e8. [PMID: 35452654 DOI: 10.1016/j.ajog.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/26/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Uncertain fetal head engagement represents 4% of obstetrical situations associated with an increased risk of postpartum hemorrhage, notably in cases of cesarean delivery and increased neonatal impairment owing to failed vaginal instrumental delivery. In this obstetrical condition, cesarean delivery is recommended, but vaginal delivery is possible in two-thirds of the cases. During the second stage of labor, the descent of the fetal head can be assessed by sonography, particularly by measuring the angle of progression. OBJECTIVE To evaluate, after a prolonged second stage of labor, the impact of measuring the angle of progression in addition to a digital examination on cesarean delivery rates when fetal head engagement remains uncertain. STUDY DESIGN This open multicenter randomized pragmatic trial included women at term with a singleton cephalic fetus in a clinical occiput anterior position after a prolonged 2-hour second stage of labor with uncertain fetal head engagement. After inclusion in the study, an independent investigator performed ultrasound systematically to confirm the occiput anterior position and measured the angle of progression at the climax of Valsalva pushing. This operator did not participate in labor management. In the study group but not in the control group, the angle of progression was communicated to the obstetrician in charge of labor management. Obstetricians were encouraged to attempt vaginal birth if the angle of progression was >120°. The primary outcome was the cesarean delivery rate. Secondary outcomes were operative delivery rate (cesarean delivery and operative vaginal delivery), maternal complications (third and fourth-degree perineal tears, failed vaginal instrumental delivery, postpartum hemorrhage, hysterectomy), and neonatal outcomes (Apgar score <5 at 10 minutes, umbilical arterial pH <7.10, neonatal wounds, neonatal intensive care unit admission). RESULTS A total of 45 women were included in the study. Occiput anterior position was confirmed in 33 women: 16 in the study group and 17 in the control group. Women's characteristics at baseline were similar between the groups. The median (range) angles of progression were similar: 138.4° (15) and 140.3° (16.9) in the study and control group, respectively. Cesarean delivery rates were 12.5% in the study group and 41.1% in the control group (P=.06). Secondary outcomes were similar between the 2 groups. No failed vaginal instrumental delivery was reported. CONCLUSION Measurement of the angle of progression in addition to digital examination when fetal head engagement remained uncertain showed promising results in decreasing cesarean delivery rates. A larger multicenter randomized controlled trial is needed to confirm these results.
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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.
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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
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10
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Youssef A, Brunelli E, Pilu G, Dietz HP. The maternal pelvic floor and labor outcome. Am J Obstet Gynecol MFM 2021; 3:100452. [PMID: 34365028 DOI: 10.1016/j.ajogmf.2021.100452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022]
Abstract
Vaginal birth is the major cause of pelvic floor damage. The development of transperineal ultrasound has improved our understanding of the relationship between vaginal birth and pelvic floor dysfunction. The female pelvic floor dimensions and function can be assessed reliably in pregnant women. Maternal pushing associated with pelvic floor muscle relaxation is the central requirement of vaginal birth. Many studies have evaluated the role of the pelvic floor on labor outcomes. Smaller levator hiatal dimensions and incomplete or absent levator ani muscle relaxation seem to be associated with a longer duration of the second stage of labor and a higher risk of cesarean and operative deliveries. Here, we presented an overview of the current knowledge of the correlation between female pelvic floor dimension and function, as assessed by transperineal ultrasound, and labor outcome.
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Affiliation(s)
- Aly Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Drs Youssef, Brunelli, and Pilu); Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy (Drs Youssef, Brunelli, and Pilu).
| | - Elena Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Drs Youssef, Brunelli, and Pilu); Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy (Drs Youssef, Brunelli, and Pilu)
| | - Gianluigi Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Drs Youssef, Brunelli, and Pilu); Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy (Drs Youssef, Brunelli, and Pilu)
| | - Hans Peter Dietz
- Sydney Medical School Nepean, Department of O&G, University of Sydney, Penrith, New South Wales, Australia (Dr Dietz)
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11
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Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery. Am J Obstet Gynecol MFM 2021; 3:100439. [PMID: 34216834 DOI: 10.1016/j.ajogmf.2021.100439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
Inaccurate assessment of the fetal head position and station might increase the risk for difficult or failed assisted vaginal delivery. Compared with digital vaginal examination, an ultrasound examination is objective and more accurate. The International Society of Ultrasound in Obstetrics and Gynecology has issued practical guidelines on intrapartum ultrasound in 2018 and recommended that an ultrasound assessment should be conducted when there is suspected delay or arrest of the first or second stage of labor or before considering assisted vaginal delivery. Fetal head position is assessed transabdominally by identifying the fetal occiput, orbit, or midline cerebral echo. Studies have shown that ultrasound assessment improved the correct diagnosis of fetal head position and accuracy of instrument placement, however, it did not reduce morbidity. Studies on ultrasound assessment of asynclitism are limited but show promising results. Fetal head station is assessed transperineally in the midsagittal or axial plane. Of the various ultrasound parameters, angle of progression and head-perineum distance are the most widely studied and found to be highly correlated with the clinical fetal head station. An angle of progression of 120° correlates with a clinical head station of 0 and is an important landmark for engagement of successful vaginal delivery, whereas an angle of progression of 145° correlates with a clinical head station of ≥+2 and has been associated with successful assisted vaginal delivery. In contrast, a head perineum distance of ≥40 mm has been associated with an increased risk for difficult assisted vaginal delivery. A "head-up" direction of descent assessed transperineally in sagittal plane is also a favorable factor for successful vaginal delivery. Current evidence seems to suggest that a prediction model with >1 sonographic parameter performed better than a model that only used 1 parameter. We suggest that an algorithm model incorporating both clinical and sonographic parameters would be useful in guiding clinicians on their decision for assisted vaginal delivery.
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12
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Ramphul M. "Strategies to increase the accuracy and safety of OVD" (Clinical assessment skills and role of ultrasound, simulation training and new technologies to enhance instrument application). Best Pract Res Clin Obstet Gynaecol 2019; 56:35-46. [PMID: 30910445 DOI: 10.1016/j.bpobgyn.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Abstract
Operative vaginal delivery (OVD) is commonly performed in the UK and Ireland. With skillful practice, the risks to mothers and babies are low. Caesarean section at full dilatation, particularly after failed OVD, can be more hazardous for mothers and babies. It is important to maintain and develop skills in OVD in order to provide it as a safe delivery option when the benefits outweigh the risks. As ultrasound machines have become more readily available on the labour ward, ultrasound assessment has been used to help clinicians diagnose the fetal head position and station, and also to try predict the success of the delivery. Simulation training has successfully been used in the setting of obstetric emergencies and is being developed to teach both technical and communication skills in OVD in order to improve maternal and neonatal outcomes. In this chapter we will discuss strategies to improve the accuracy and safety of OVD in more details.
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Affiliation(s)
- M Ramphul
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, UK.
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13
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Youssef A, Kamel R. Ultrasound in labor: impact of a theoretical and practical course on caregiver's perspective and accuracy. J Matern Fetal Neonatal Med 2019; 33:3163-3169. [PMID: 30700229 DOI: 10.1080/14767058.2019.1570113] [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] [Indexed: 10/27/2022]
Abstract
Objective: The aim of the present study was two-fold; first is to assess the impact of a theoretical and practical course on the caregiver's perspective on the use of ultrasound in labor. Second is to evaluate the impact of the course on the measurement of the angle of progression.Materials and methods: Obstetricians participating in the course responded twice to a questionnaire addressing the caregiver's perspective on the use of ultrasound in labor, before and at the end of the course. In addition, all participants measured the angle of progression on a digital simulation software once following the theoretical part and a second time after the conclusion of both the theoretical and practical sessions. All answers to the questionnaire were compared before versus after the course. The angle of progression assessments after the theoretical part and those after the course were compared with those performed by an expert operator.Results: Overall, data from 51 participants were analyzed. In comparison with the pre-course questionnaire, more participants after the course believed ultrasound can be a useful instrument for fetal occiput presentation diagnosis (45; 88.2% versus 26; 51%, p < .001) and for fetal head progression evaluation (37; 72.5% versus 19; 37.3%; p < .001). Although before the course, most participants (32; 62.7%) thought that the transperineal parameters were too complex to be applied, only 19 (37.3%) still considered the complexity of the ultrasound indices, an obstacle against their application in clinical practice after the course (p = .002). Regarding the angle of progression, precourse measurements showed a systematic overestimation in comparison with the gold standard. Furthermore, the coefficient of variation, more than halved following the practical simulation reflecting at least a doubling of the angle of progression (AoP) measurement precision (14.2 versus 5.5%).Conclusions: A theoretical and practical course conducted by expert operators may positively change obstetricians' perspective on the use of ultrasound in labor. Moreover, a practical session seems to improve the participants' accuracy and precision in the assessment of fetal head descent by transperineal ultrasound.
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Affiliation(s)
- Aly Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Rasha Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt
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Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, Salomon LJ, Tutschek B. ISUOG Practice Guidelines: intrapartum ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:128-139. [PMID: 29974596 DOI: 10.1002/uog.19072] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
The purpose of these Guidelines is to review the published techniques of ultrasound in labor and their practical applications, to summarize the level of evidence regarding the use of ultrasound in labor and to provide guidance to practitioners on when ultrasound in labor is clinically indicated and how the sonographic findings may affect labor management. We do not imply or suggest that ultrasound in labor is a necessary standard of care.
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Affiliation(s)
- T Ghi
- Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - C Lees
- Centre for Fetal Care, Queen Charlottes and Chelsea Hospital, London, UK
| | - K Kalache
- Sidra Medical and Research Center, Doha, Qatar
| | - P Rozenberg
- Centre Hospitalier Poissy Saint Germain, Obstetrics & Gynaecology, Paris, France
| | - A Youssef
- Obstetrics and Gynecology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - L J Salomon
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université Paris Descartes, Maternité, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, SFAPE
| | - B Tutschek
- Prenatal Zurich, Heinrich-Heine-University, Medical Faculty, Zürich, Switzerland
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Chor CM, Poon LCY, Leung TY. Prediction of labor outcome using serial transperineal ultrasound in the first stage of labor. J Matern Fetal Neonatal Med 2017; 32:31-37. [DOI: 10.1080/14767058.2017.1369946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chung Ming Chor
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Liona Chiu Yee Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
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16
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Perlman S, Kivilevitch Z, Moran O, Katorza E, Kees S, Achiron R, Gilboa Y. Correlation between clinical fetal head station and sonographic angle of progression during the second stage of labor. J Matern Fetal Neonatal Med 2017; 31:2905-2910. [DOI: 10.1080/14767058.2017.1359533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sharon Perlman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Kivilevitch
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Orit Moran
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salim Kees
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yinon Gilboa
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kahrs BH, Usman S, Ghi T, Youssef A, Torkildsen EA, Lindtjørn E, Østborg TB, Benediktsdottir S, Brooks L, Harmsen L, Romundstad PR, Salvesen KÅ, Lees CC, Eggebø TM. Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study. Am J Obstet Gynecol 2017; 217:69.e1-69.e10. [PMID: 28327433 DOI: 10.1016/j.ajog.2017.03.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Safe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions should be focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery. Prolonged attempts at vacuum delivery are associated with neonatal morbidity and maternal trauma, especially so if the procedure is unsuccessful and a cesarean is performed. OBJECTIVE The aim of the study was to assess if ultrasound measurements of fetal position and station can predict duration of vacuum extractions, mode of delivery, and fetal outcome in nulliparous women with prolonged second stage of labor. STUDY DESIGN We performed a prospective cohort study in nulliparous women at term with prolonged second stage of labor in 7 European maternity units from 2013 through 2016. Fetal head position and station were determined using transabdominal and transperineal ultrasound, respectively. Our preliminary clinical experience assessing head-perineum distance prior to vacuum delivery suggested that we should set 25 mm for the power calculation, a level corresponding roughly to +2 below the ischial spines. The main outcome was duration of vacuum extraction in relation to ultrasound measured head-perineum distance with a predefined cut-off of 25 mm, and 220 women were needed to discriminate between groups using a hazard ratio of 1.5 with 80% power and alpha 5%. Secondary outcomes were delivery mode and umbilical artery cord blood samples after birth. The time interval was evaluated using survival analyses, and the outcomes of delivery were evaluated using receiver operating characteristic curves and descriptive statistics. Results were analyzed according to intention to treat. RESULTS The study population comprised 222 women. The duration of vacuum extraction was shorter in women with head-perineum distance ≤25 mm (log rank test <0.01). The estimated median duration in women with head-perineum distance ≤25 mm was 6.0 (95% confidence interval, 5.2-6.8) minutes vs 8.0 (95% confidence interval, 7.1-8.9) minutes in women with head-perineum distance >25 mm. The head-perineum distance was associated with spontaneous delivery with area under the curve 83% (95% confidence interval, 77-89%) and associated with cesarean with area under the curve 83% (95% confidence interval, 74-92%). In women with head-perineum distance ≤35 mm, 7/181 (3.9%) were delivered by cesarean vs 9/41 (22.0%) in women with head-perineum distance >35 mm (P <.01). Ultrasound-assessed position was occiput anterior in 73%. Only 3/138 (2.2%) fetuses in occiput anterior position and head-perineum distance ≤35 mm vs 6/17 (35.3%) with nonocciput anterior position and head-perineum distance >35 mm were delivered by cesarean. Umbilical cord arterial pH <7.10 occurred in 2/144 (1.4%) women with head-perineum distance ≤35 mm compared to 8/40 (20.0%) with head-perineum distance >35 mm (P < .01). CONCLUSION Ultrasound has the potential to predict labor outcome in women with prolonged second stage of labor. The information obtained could guide whether vacuum delivery should be attempted or if cesarean is preferable, whether senior staff should be in attendance, and if the vacuum attempt should be performed in the operating theater.
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18
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Takahashi M, Takeda J, Ono Y, Nagai T, Seki H, Takeda S. Safety and reliability of forceps delivery based on a 3-dimensional fetal head evaluation: a retrospective study. HYPERTENSION RESEARCH IN PREGNANCY 2017. [DOI: 10.14390/jsshp.hrp2017-016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Masaya Takahashi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| | - Yoshihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University
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19
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Arthuis CJ, Perrotin F, Patat F, Brunereau L, Simon EG. Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:779-785. [PMID: 26678354 DOI: 10.1002/uog.15842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU). METHODS All computed tomography (CT) scans performed for breech presentation and for twin delivery between 2006 and 2014 in a tertiary university hospital were obtained for measurement and analysis by two operators. The symphysis-left ischial spine angle (SIA) and the symphysis-left ischial spine distance (SID) were measured on three-dimensional reconstructions from the CT volume dataset. We calculated intra- and interobserver agreements for SIA and SID with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement and estimated the intraclass correlation coefficient (ICC). A sagittal plane projection from the SIA enabled calculation of a sagittal angle, corresponding to the angle of progression (AoP) on ITU. RESULTS SIA and SID were obtained from CT images from 458 women. Reproducibility was good for both SIA (intraobserver ICC, 0.94 (95% CI, 0.88-0.97) and interobserver ICC, 0.81 (95% CI, 0.66-0.92)) and SID (intraobserver ICC, 0.92 (95% CI, 0.82-0.97) and interobserver ICC, 0.83 (95% CI, 0.73-0.92)). The median SIA was 106° (interquartile range (IQR), 105-109°) and median SID was 26.1 (IQR, 23.4-29.5) mm. SIA and SID were not correlated with pelvic diameter or height. The 50th percentile of AoP was 110°. CONCLUSION Knowledge of the anatomical relationship between the pubic symphysis and ischial spines makes it possible to establish a sonographic method for assesssing fetal head descent by taking into account the level of the ischial spines. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C J Arthuis
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - F Perrotin
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
| | - F Patat
- Inserm U930, François-Rabelais University, Tours, France
- Centre Investigation Clinique-Innovation Technologique, CIC 1415 Inserm - University Hospital Center of Tours, Tours, France
| | - L Brunereau
- University Hospital Center of Tours, Department of Diagnostic and Interventional Radiology-Neuroradiology, Center for Medical Imaging, Tours, France
| | - E G Simon
- University Hospital Center of Tours, Department of Obstetrics, Gynecology and Fetal Medicine, Tours, France
- Inserm U930, François-Rabelais University, Tours, France
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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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The Angle of Progression at Station 0 and in Magnetic Resonance and Transperineal Ultrasound Assessment. Case Rep Obstet Gynecol 2015; 2015:748327. [PMID: 26483980 PMCID: PMC4592901 DOI: 10.1155/2015/748327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/06/2015] [Accepted: 09/10/2015] [Indexed: 11/17/2022] Open
Abstract
The transperineal ultrasound (TPU) value of the angle of progression (AOP) during fetal head engagement, at station 0, is a critical cut-off for current obstetrical practice, especially when intrapartum instrumental interventions are required. Still, controversial measurements were reported in previous high resolution imagistic studies. Our TPU and direct “gold-standard” magnetic resonance (MRI) measurements confirm that station 0 corresponds to a 120° AOP, concordantly. Based on these findings, the fact that an AOP of 120° or greater was previously strongly associated with vaginal delivery may be due to the achievement of head engagement in labor.
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22
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Marsoosi V, Pirjani R, Mansouri B, Eslamian L, Jamal A, Heidari R, Rahimi-Foroushani A. Role of ‘angle of progression’ in prediction of delivery mode. J Obstet Gynaecol Res 2015; 41:1693-9. [DOI: 10.1111/jog.12798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/09/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Vajiheh Marsoosi
- Obstetrics and Gynecology Department; Tehran University of Medical Sciences; Tehran Iran
| | - Reihaneh Pirjani
- Obstetrics and Gynecology Department; Tehran University of Medical Sciences; Tehran Iran
| | - Baharak Mansouri
- Obstetrics and Gynecology Department; Tehran University of Medical Sciences; Tehran Iran
| | - Laleh Eslamian
- Obstetrics and Gynecology Department; Tehran University of Medical Sciences; Tehran Iran
| | - Ashraf Jamal
- Obstetrics and Gynecology Department; Tehran University of Medical Sciences; Tehran Iran
| | - Reza Heidari
- School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Abbas Rahimi-Foroushani
- Epidemiology and Biostatistics Department, School of Public Health Sciences; Tehran University of Medical Sciences; Tehran Iran
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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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Takeda S, Takeda J, Koshiishi T, Makino S, Kinoshita K. Fetal station based on the trapezoidal plane and assessment of head descent during instrumental delivery. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University
| | - Jun Takeda
- Department of Obstetrics and Gynecology, Juntendo University
| | - Taro Koshiishi
- Department of Obstetrics and Gynecology, Juntendo University
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University
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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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Fouché CJ, Simon EG, Potin J, Perrotin F. Le suivi échographique de la deuxième partie du travail. ACTA ACUST UNITED AC 2012; 40:658-65. [DOI: 10.1016/j.gyobfe.2012.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Indexed: 10/27/2022]
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Levy R, Zaks S, Ben-Arie A, Perlman S, Hagay Z, Vaisbuch E. Can angle of progression in pregnant women before onset of labor predict mode of delivery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:332-337. [PMID: 22605649 DOI: 10.1002/uog.11195] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The angle of progression (AOP), measured by transperineal ultrasound, has been used to assess fetal head descent during labor. Our aim was to assess whether, before onset of labor, parous women have a narrower AOP than do nulliparous women and if a narrow AOP is associated with a higher rate of Cesarean delivery. METHODS In this prospective, observational study, we performed transperineal ultrasound in pregnant women not yet in labor at ≥ 39 weeks' gestation who delivered within 1 week of sonography. The AOP was compared as follows: in nulliparous women, between those who had a Cesarean section and those who delivered vaginally; and among women who delivered vaginally, between those who were nulliparous and those who were parous. RESULTS Included in the study were 100 nulliparous and 71 parous women. Among those who delivered vaginally (n = 161), the median AOP before onset of labor was narrower in parous than in nulliparous women (98° (interquartile range (IQR)), 90-107° vs 104° (IQR, 97-113°), P < 0.001). Among the 100 nulliparous women, (1) the median AOP before onset of labor was narrower in those who went on to deliver by Cesarean section (n = 9) than in those delivered vaginally (n = 91) (90° (IQR, 85.5-93.5°) vs 104° (IQR, 97-113°), P < 0.001); (2) an AOP ≥ 95° (derived from the receiver-operating characteristics curve) was associated with vaginal delivery in 99% of women; and (3) 89% (8/9) of women who delivered by Cesarean section had an AOP < 95°. Among the 71 parous women, only one delivered by Cesarean section and all of those with an AOP < 95° delivered vaginally. CONCLUSION A narrow AOP (< 95°) in non-laboring nulliparous women at term is associated with a high rate of Cesarean delivery. Parous women have a narrower AOP than do nulliparous women before the onset of labor; however, unlike in nulliparous women, a narrow AOP in parous women does not appear to be associated with Cesarean delivery and most parous women with such an angle go on to deliver vaginally.
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Affiliation(s)
- R Levy
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to Hebrew University and Hadassah School of Medicine, Jerusalem, Israel.
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Sherer DM. Can sonographic depiction of fetal head position prior to or at the onset of labor predict mode of delivery? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:1-6. [PMID: 22753319 DOI: 10.1002/uog.11213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- D M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, 450 Clarkson Avenue, Box 24, Brooklyn, NY 11203, USA.
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Bamberg C, Rademacher G, Güttler F, Teichgräber U, Cremer M, Bührer C, Spies C, Hinkson L, Henrich W, Kalache KD, Dudenhausen JW. Human birth observed in real-time open magnetic resonance imaging. Am J Obstet Gynecol 2012; 206:505.e1-6. [PMID: 22425409 DOI: 10.1016/j.ajog.2012.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge about the mechanism of labor is based on assumptions and radiographic studies performed decades ago. The goal of this study was to describe the relationship between the fetus and the pelvis as the fetus travels through the birth canal, using an open magnetic resonance imaging (MRI) scanner. STUDY DESIGN The design of the study used a real-time MRI series during delivery of the fetal head. RESULTS Delivery occurred by progressive head extension. However, extension was a very late movement that was observed when the occiput was in close contact with the inferior margin of the symphysis pubis, occurring simultaneously with gliding downward of the fetal head. CONCLUSION This observational study shows, for the first time, that birth can be analyzed with real-time MRI. MRI technology allows assessment of maternal and fetal anatomy during labor and delivery.
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Bamberg C, Scheuermann S, Fotopoulou C, Slowinski T, Dückelmann AM, Teichgräber U, Streitparth F, Henrich W, Dudenhausen JW, Kalache KD. Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound. Am J Obstet Gynecol 2012; 206:161.e1-5. [PMID: 22177192 DOI: 10.1016/j.ajog.2011.10.867] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/18/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During labor, transperineal sonography is increasingly used to evaluate fetal head descent. The aim of this study was to compare the angle of progression assessed by open magnetic resonance imaging (MRI) vs transperineal ultrasound. STUDY DESIGN A total of 31 pregnant women at term (>37 weeks), who were not in labor, underwent MRI in an open 1.0-T system. A midsagittal plane of the maternal pelvis was stored. Immediately after, without changing the supine position, a transperineal ultrasound was performed. The angle of progression was measured offline by transperineal ultrasound and MRI. RESULTS The angles of progression measured by transperineal ultrasound (mean, 79.05 degrees; SD 11.44) and MRI (mean, 80.48 degrees; SD 11.06) correlated significantly (P < .001). The intraclass correlation coefficient between the 2 methods was 0.89 (95% confidence interval, 0.78-0.94). CONCLUSION The angle of progression measurements obtained by transperineal ultrasound and open MRI showed very good agreement.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany.
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