Dynamic changes of fetal head descent at term before the onset of labor correlate with labor outcome and can be improved by ultrasound visual feedback

Youssef, A.; Dodaro, Maria Gaia; Consolini, Silvia; Ciarlariello, S.; Farina, Antonio; Bellussi, Federica; Rizzo, Nicola; Pilu, Gianluigi

doi:10.1080/14767058.2019.1651266

Cited by 16 publications

(13 citation statements)

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“…An association between lower fetal head station on TPU and outcome of labor has been demonstrated in many studies. Indeed, a narrower AoP (indicating a higher fetal head station and thus less engagement) has been shown consistently to be associated with a higher risk of Cesarean delivery, longer duration of labor, failure of instrumental delivery and failure of induction of labor 15,23,34,35,45 . In the present study, we confirmed that a narrower AoP at term is associated with a higher risk of Cesarean delivery in nulliparous women.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Antenatal pelvic floor education has been assessed. Salvesen and Mørkved 46 found that a structured pelvic floor training program was associated with a shorter second stage of labor and Youssef et al 35 showed that visual feedback using ultrasound in nulliparous women before the onset of labor can help women push more efficiently. On the other hand, Phipps et al 47 failed to identify a positive clinical impact of antenatal education using observation of the perineum and vaginal examination.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several studies have found a correlation between pelvic floor dimensions and levator ani muscle (LAM) coactivation at term and the outcome of labor 29–33 . The AoP at term has a strong association with the risk of Cesarean delivery and with duration of labor 15,23,26,34–37 , but the correlation between fetal head engagement and pelvic floor dimensions has not been assessed previously.…”

Section: Introductionmentioning

confidence: 99%

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Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

Youssef

Brunelli

Montaguti

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. Methods This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. Results In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean‐delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). Conclusions Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

Youssef

Brunelli

Montaguti

et al. 2020

Ultrasound in Obstet & Gyne

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“…Indeed, coaching and ultrasound aided visual feedback to demonstrate to women how to properly push down was found to be successful in alleviating coactivation in many cases. 86…”

Section: Assessment Of Pelvic Floor Dimensions and Functionmentioning

confidence: 99%

The usefulness of ultrasound before induction of labor

Kamel

Garcia

Poon

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Fetal head progression and regression on maternal pushing at term and labor outcome

Youssef

Brunelli

Azzarone

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives The aim of our study was two‐fold. First, to evaluate the association between the change in the angle of progression (AoP) on maternal pushing and labor outcome. Second, to assess the incidence and clinical significance of the reduction of AoP on maternal pushing. Methods This was a prospective cohort study of nulliparous women with singleton pregnancy at term. AoP was measured at rest and on maximum Valsalva maneuver before the onset of labor, and the difference between AoP on maximum Valsalva and that at rest (ΔAoP) was calculated for each woman. Following delivery and data collection, we assessed the association between ΔAoP and various labor outcomes, including Cesarean section (CS), duration of the first, second and active second stages of labor, Apgar score and admission to the neonatal intensive care unit (NICU). The prevalence of women with reduction of AoP on maximum Valsalva maneuver (AoP‐regression group) was calculated and its association with the mode of delivery and duration of different stages of labor was assessed. Results Overall, 469 women were included in the analysis. Among these, 273 (58.2%) had spontaneous vaginal birth, 65 (13.9%) had instrumental delivery and 131 (27.9%) underwent CS. Women in the CS group were older, had narrower AoP at rest and on maximum Valsalva, higher rate of epidural administration and lower 1‐min and 5‐min Apgar scores in comparison with the vaginal‐delivery group. ΔAoP was comparable between the two groups. On Pearson's correlation analysis, AoP at rest and on maximum Valsalva maneuver had a significant negative correlation with the duration of the first stage of labor. ΔAoP showed a significant negative correlation with the duration of the active second stage of labor (Pearson's r, −0.125; P = 0.02). Cox regression model analysis showed that ΔAoP was associated independently with the duration of the active second stage (hazard ratio, 1.014 (95% CI, 1.003–1.025); P = 0.012) after adjusting for maternal age and body mass index. AoP reduction on maximum Valsalva was found in 73 (15.6%) women. In comparison with women who showed no change or an increase in AoP on maximum Valsalva, the AoP‐regression group did not demonstrate significant difference in maternal characteristics, mode of delivery, rate of epidural analgesia, duration of the different stages of labor or rate of NICU admission. Conclusions In nulliparous women at term before the onset of labor, narrower AoP at rest and on maximum Valsalva, reflecting fetal head engagement, is associated with a higher risk of Cesarean delivery. The increase in AoP from rest to Valsalva, reflecting more efficient maternal pushing, is associated with a shorter active second stage of labor. Fetal head regression on maternal pushing is present in about 16% of women and does not appear to have clinical significance. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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Dynamic changes of fetal head descent at term before the onset of labor correlate with labor outcome and can be improved by ultrasound visual feedback

Cited by 16 publications

References 30 publications

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

The usefulness of ultrasound before induction of labor

Fetal head progression and regression on maternal pushing at term and labor outcome

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