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Yano E, Sayama S, Iriyama T, Ariyoshi Y, Akiba N, Ichinose M, Toshimitsu M, Seyama T, Kumasawa K, Nakayama T, Kobayashi K, Nagamatsu T, Hirota Y, Osuga Y. Prediction of spontaneous vaginal delivery in the prolonged second stage using the delta angle of progression. Am J Obstet Gynecol MFM 2024:101403. [PMID: 38880239 DOI: 10.1016/j.ajogmf.2024.101403] [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: 02/25/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND It is clinically challenging to determine when to intervene in the prolonged second stage. Although individualized prediction of spontaneous vaginal delivery is crucial to avoid maternal and neonatal complications associated with operative deliveries, the approach has not been fully established. OBJECTIVES We aimed to evaluate the predictability of spontaneous vaginal delivery using the difference in angle of progression between pushing and rest, delta angle of progression, to establish a novel method to predict spontaneous vaginal delivery during the prolonged second stage in nulliparous women with epidural anesthesia. STUDY DESIGN We retrospectively analyzed deliveries of nulliparous women with epidural anesthesia between September 2018 and October 2023. Women were included if their delta angle of progression during the second stage was available. Operative deliveries were defined as the cases that required forceps, vacuum, and cesarean deliveries due to labor arrest. Women requiring operative deliveries due to fetal and maternal concerns, or women with fetal occiput posterior presentation were excluded. The second stage was stratified into the prolonged second stage, the period after three hours in the second stage, and the normal second stage, the period from the beginning until the third hour of the second stage. The association of the delta angle of the progression measured during each stage with spontaneous vaginal delivery and operative deliveries was investigated. Furthermore, the predictability of spontaneous vaginal delivery was evaluated by combining the delta and rest angle of progression. RESULTS A total of 129 women were eligible for analysis. The delta angle of progression measured during the prolonged second stage and normal second stage were significantly larger in women who achieved spontaneous vaginal delivery compared to operative deliveries (p<0.001 and p<0.05, respectively). During the prolonged second stage, a cutoff of 18.8 derived from the receiver operative characteristic curves in the context of the delta angle of progression predicted the possibility of spontaneous vaginal delivery (sensitivity, 81.8%; specificity, 60.0%; AUC, 0.76). Combining the rest angle of progression (>140) and delta angle of progression (>18.8) also provided quantitative prediction of spontaneous vaginal delivery (sensitivity, 86.7%; specificity, 70.0%; AUC, 0.80). CONCLUSION The delta angle of progression alone or in combination with the rest angle of progression can be used to predict spontaneous vaginal delivery in the second stage in nulliparous women with epidural anesthesia. Quantitative analysis of the effect of pushing using the delta angle of progression provides an objective guide to assist with an assessment of labor dystocia in the prolonged second stage on an individualized basis, which may optimize labor management in the prolonged second stage by reducing neonatal and maternal complications related to unnecessary operative deliveries and prolonged second stage of labor.
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Affiliation(s)
- Eriko Yano
- Department of Obstetrics and Gynecology, 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.
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Ariyoshi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoya Akiba
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, 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
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshio Nakayama
- Department of Obstetrics and Gynecology, Sanno Hospital, Tokyo, Japan
| | - Koichi Kobayashi
- Department of Obstetrics and Gynecology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Nouri-Khasheh-Heiran E, Montazeri A, Conversano F, Kashanian M, Rasuli M, Rahimi M, Mirpour M, Akbari N. The success of vaginal birth by use of trans-labial ultrasound plus vaginal examination and vaginal examination only in pregnant women with labor induction: a comparative study. BMC Pregnancy Childbirth 2023; 23:3. [PMID: 36597037 PMCID: PMC9809008 DOI: 10.1186/s12884-022-05324-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. Thus, this study aimed to compare the success rate of vaginal birth by using trans-labial ultrasound and vaginal examination, and vaginal examination only in pregnant women with labor induction. METHODS This was a comparative study including 392 eligible pregnant women with labor induction attending to a teaching hospital affiliated with Iran University of Medical Sciences from April to October 2018 in Tehran, Iran. Women were randomly assigned to two groups; the trans-labial ultrasound plus vaginal examination (group A), and the vaginal examination only (group B). Women were included in the study if they satisfied the following criteria: singleton pregnancy, 37 to 42 weeks of gestational age, fetal head presentation, a living fetus with no abnormalities, uncomplicated pregnancy, and no previous cesarean section or any uterine surgery. We used a partograph for both groups to assess the fetal head position and the fetal head station. In group 1, the Angle of Progression (AoP) and Rotation Angle (RA) were also assessed. Finally, the success and progression of vaginal delivery in two groups were compared by predicting the duration of delivery and mode of delivery. RESULTS The findings showed that 8.68% of women in the trans-labial plus vaginal examination group delivered by cesarean section, while 6.13% in the vaginal examination only group delivered by cesarean section (P = 0.55). In women with cesarean section in positive fetal head stations, Angle of Progression (AoP) was significantly decreased ranging from 90 to 135 degrees compared to women who delivered vaginally (135-180 degrees; P < 0.001). In addition, the Rotation Angle (RA) was significantly decreased in women with cesarean section ranging from 0 to 30 degrees compared to women who delivered vaginally (60-90degrees; P < 0.001). Further analysis indicated that a higher risk of cesarean section was associated with vaginal examination only as compared to trans-labial ultrasound plus vaginal examination (HR: 8.65, P < 0.001). CONCLUSION Angle of Progression (AoP) and Rotation Angle (RA) indexes might be useful parameters to predict labor progression and successful vaginal delivery among women undergoing labor induction.
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Affiliation(s)
- Elmira Nouri-Khasheh-Heiran
- grid.411746.10000 0004 4911 7066Department of Reproductive Health and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, The Academic Center for Education, Culture and Research (ACECR), Tehran, Iran ,grid.444904.90000 0004 9225 9457Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
| | - Francesco Conversano
- grid.5326.20000 0001 1940 4177National Research Council, Institute of Clinical Physiology, Lecce, Italy
| | - Maryam Kashanian
- grid.411746.10000 0004 4911 7066Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Rasuli
- grid.411746.10000 0004 4911 7066Department of Biostatistics, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahimi
- grid.411746.10000 0004 4911 7066Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mirpour
- grid.411583.a0000 0001 2198 6209Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Akbari
- grid.411746.10000 0004 4911 7066Department of Reproductive Health and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Santana EFM, Castello RG, Passos MET, Ribeiro GCF, Araujo Júnior E. How to Reach the Best Ultrasound Performance in the Delivery Room. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1070-1077. [PMID: 36580951 PMCID: PMC9800070 DOI: 10.1055/s-0042-1759773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
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Affiliation(s)
- Eduardo Félix Martins Santana
- Medical Course, Albert Einstein Medical School, São Paulo, SP, Brazil.,Fetal Medicine Unit, Albert Einstein Hospital, São Paulo, SP, Brazil.
| | | | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil.,Medical Course, Municipal University of Sao Caetano do Sul, São Paulo, SP, Brazil.,Address for correspondence Edward Araujo Junior, PhD Rua Borges Lagoa, 1341, 04038-034, Vila Clementino, São Paulo, SPBrazil
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Mendes S, Silva R, Martins I, Santo S, Clode N. Mueller-Hillis maneuver and angle of progression: Are they correlated? Rev Assoc Med Bras (1992) 2017; 63:527-531. [PMID: 28876429 DOI: 10.1590/1806-9282.63.06.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: Mueller-Hillis maneuver (MHM) and angle of progression (AOP) measured by transperineal ultrasound have been used to assess fetal head descent during the second stage of labor. We aimed to assess whether AOP correlates with MHM in the second stage of labor. Method: A prospective observational study including women with singleton pregnancy in the second stage of labor was performed. The AOP was measured immediately after the Mueller-Hillis maneuver. A receiver-operating characteristics (ROC) curve analysis was performed to determine the best discriminatory AOP cut-off for the identification of a positive MHM. A p-value less than 0.05 was considered statistically significant. Results: One hundred and sixty-six (166) women were enrolled in the study and 81.3% (n=135) had a positive MHM. The median AOP was 143º (106º to 210º). The area under the curve for the prediction of a positive maneuver was 0.619 (p=0.040). Derived from the ROC curve, an AOP of 138.5º had the best diagnostic performance for the identification of a positive MHM (specificity of 65% and a sensitivity of 67%). Conclusion: An AOP of 138º seems to be associated with a positive MHM in the second stage of labor.
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Affiliation(s)
- Sofia Mendes
- MD, Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisboa, Portugal
| | - Rita Silva
- MD, Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisboa, Portugal
| | - Inês Martins
- MD, Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisboa, Portugal
| | - Susana Santo
- MD, Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisboa, Portugal
| | - Nuno Clode
- MD, Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria, Lisboa, Portugal
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