[Measurement of the infrapubic angle using 3D perineal ultrasound and its relationship to obstetrical parameters]

Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery

BACKGROUND

Numerous variables are linked to the success of vaginal delivery, including the subpubic arch angle (SPAA) during labor, the importance of which has not yet been fully elucidated.

AIM

To examine the SPAA distributional characteristics and to ascertain SPAA's ability to predict the type and duration of labor.

METHODS

We determined the SPAA and analyzed the corresponding data. We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression. The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021.

RESULTS

Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81° and a maximum angle of 122.2°. The angle in the normal vaginal delivery group was greater than that in the labor cesarean group (P = 0.000). The SPAA was a highly significant positive predictor of normal vaginal delivery (P = 0.000) with an area under the curve of 0.782 (P = 0.000; 95%CI: 0.717-0.848). We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis (P = 0.045).

CONCLUSION

The SPAA was a highly significant positive predictor of normal vaginal delivery. The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

Predictive value of the trans-perineal three-dimensional ultrasound measurement of the pubic arch angle for vaginal delivery

BACKGROUND

Numerous variables are linked to the success of vaginal delivery, including the subpubic arch angle (SPAA) during labor, the importance of which has not yet been fully elucidated.

AIM

To examine the SPAA distributional characteristics and to ascertain SPAA’s ability to predict the type and duration of labor.

METHODS

We determined the SPAA and analyzed the corresponding data. We also evaluated the relationship between the SPAA and the mode of delivery and the duration of labor by regression. The present study comprised a total of 301 pregnant women who had given birth at Beijing Tiantan Hospital of the Capital Medical University between January and December of 2021.

RESULTS

Our analysis of 301 pregnant women revealed that the SPAA measured using three-dimensional trans-perineal ultrasound had a minimum angle of 81° and a maximum angle of 122.2°. The angle in the normal vaginal delivery group was greater than that in the labor cesarean group (P = 0.000). The SPAA was a highly significant positive predictor of normal vaginal delivery (P = 0.000) with an area under the curve of 0.782 (P = 0.000; 95%CI, 0.717–0.848). We found the length of the second stage of labor to be positively influenced by the SPAA using linear regression analysis (P = 0.045).

CONCLUSION

The SPAA was a highly significant positive predictor of normal vaginal delivery. The length of the second stage of labor and normal vaginal birth were predicted by SPAA.

The usefulness of ultrasound before induction of labor

The indications for induction of labor have been consistently on the rise. These indications are mainly medical (maternal or fetal) or social or related to convenience or maternal preferences. With the increase in the prevalence of these indications, the incidence rates of induction of labor are expected to rise continuously. This poses a substantial workload and financial burden on maternity healthcare systems. Failure rates of induction of labor are relatively high, especially when considering the maternal, fetal, and neonatal risks associated with emergency cesarean deliveries in cases of failure. Therefore, it is essential for obstetricians to carefully select women who are eligible for induction of labor, particularly those with no clinical contraindication and who have a reasonable chance of ending up with a successful noncomplicated vaginal delivery. Ultrasound has an established role in the various areas of obstetrical care. It is available, accessible, easy to perform, and acceptable to the patient. In addition, the learning curve for skillful obstetrical ultrasound scanning is rather easy to fulfill. Ultrasound has always had an important role in the assessment of maternal and fetal well-being. Indeed, it has been extensively explored as a reliable, reproducible, and objective tool in the management of labor. In this review, we aimed to provide a comprehensive update on the different applications and uses of ultrasound before induction of labor for the prediction of its success and the potential improvement of its health-related maternal and fetal outcomes.

New Measures for Predicting Birth-Related Pelvic Floor Trauma

OBJECTIVES

The aim of this study was to establish the predictive role of obstetric variables for obstetric outcomes and birth related levator ani muscle (LAM) trauma.

METHODS

In this prospective study, women underwent 3-dimensional pelvic floor ultrasound at their first appointment at 36 weeks and also 3 months postpartum. The measurements included minimal levator hiatus circumference (MLHC) and the ratio of fetal head circumference to MLHC = head-induced stretch ratio (HISR) as an indicator of the discrepancy between passage and passing canal. To derive the true impact of baby's mass on the levator ani musculature, we devised the levator ani stretch ratio (LASR), which was calculated by multiplying the HISR and the baby's weight.

RESULTS

Data set of 173 women was available for analysis. Mean HISR and LASR values were statistically different across all binary outcome categories, with 1 exception for HISR and levator ani injury. The odds ratios for LASR indicated positive and statistically significant associations with all obstetric outcomes examined. The probability of the LASR correctly classifying those with the adverse obstetric outcome, as estimated by the area under the curve, ranged from 0.64 to 0.80 with the strongest discriminatory ability observed for severe LAM trauma.

CONCLUSIONS

Fetal head circumference/mother MLHC ratio (HISR) is associated with longer length of second stage of labor, assisted delivery, and increased severity of perineal trauma. Similar associations were observed for LASR, but in addition, LASR had good discriminatory ability to identify severe LAM trauma.