Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery

Rizzo, Giuseppe; Aiello, Elisa; Bosi, Costanza; D’Antonio, Francesco; Arduini, Domenico

doi:10.1111/aogs.13162

Cited by 32 publications

(16 citation statements)

References 22 publications

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“…Some authors have observed that a large head circumference rather than birthweight is strongly associated with unplanned caesarean section and instrumental delivery [30], and very recently the relationship between SPA width and head circumference in the identification of women at risk of UOI has been confirmed [31].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Subpubic Arch Angle and Mode of Delivery in Large-for-Gestational-Age Fetuses

Ghi

Dall’Asta²,

Suprani³

et al. 2017

Fetal Diagn Ther

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Objectives: A narrow subpubic arch angle (SPA) has been associated with a higher risk of operative delivery and prolonged labor. The aim of this study was to evaluate the correlation between SPA and labor outcome in a cohort of women delivering a large-for-gestational-age (LGA) fetus. Methods: An observational study involving two Italian tertiary centers (Parma and Rome) was carried out. Nulliparous women referred to the antepartum clinic between 35 and 39 weeks due to an increased risk of having an LGA fetus at birth were prospectively selected for the study purpose. Within the study cohort, SPA measurements were obtained by means of transperineal 3D ultrasound. Elective caesarean section and birth weight below 3,750 g represented exclusion criteria. In the final study group, SPA values were compared between the patients who underwent spontaneous vaginal delivery (SVD) and those who were submitted to unplanned obstetric intervention (UOI) due to prolonged or arrested labor (vacuum delivery or caesarean section). Results: Overall, 129 women were included, and the mean birthweight of the neonates was 4,066 ± 263.03 g. SVD occurred in 63 patients (48.8%), whereas UOI due to prolonged or arrested labor was performed in 66 (51.2%), including 21 cases of vacuum delivery and 45 caesarean sections. The SPA was significantly smaller among women who underwent UOI than in those who achieved SVD (107.9 ± 13.4 vs. 120.7 ± 9.4°, p < 0.001). Furthermore, SPA width was inversely correlated with labor length (p < 0.001). Multivariable logistic regression analysis showed that a smaller SPA (OR 1.091, 95% CI 1.051-1.134, p < 0.001) and an increased birthweight (OR 1.002, 95% CI 1.000-1.004, p = 0.037) were independent risk factors for operative delivery. Conclusion: SPA measurement before labor is helpful in predicting the risk of operative delivery due to prolonged or arrested labor among nulliparous women delivering LGA fetuses.

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Section: Discussionmentioning

confidence: 99%

Correlation between Subpubic Arch Angle and Mode of Delivery in Large-for-Gestational-Age Fetuses

Ghi

Dall’Asta²,

Suprani³

et al. 2017

Fetal Diagn Ther

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“…(4) The vaginal delivery depends on fetal head circumference and maternal pelvic parameters like inter ischial diameter and subpubic angle. [21] The inclusion of these parameters may improve the accuracy. 5The confounding variable effect such as epidural analgesia needs to be evaluated.…”

Section: Discussionmentioning

confidence: 99%

An ultrasound prediction model for probability of vaginal delivery in induction of labor

Garg¹,

Gómez‐Roig²,

Singla³

2019

Perinatal J

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Do¤um indüksiyonunda vajinal do¤um olas›l›¤›na yönelik ultrason tahmin modeli Amaç: Çal›flmam›zda amac›m›z, (i) vajinal do¤umun tahminine yönelik bir indüksiyon öncesi ultrason skorunu de¤erlendirerek miad›nda nullipar kad›nlardaki Bishop skoruyla karfl›laflt›rmak ve (ii) klinik kullan›m için vajinal do¤um olas›l›¤›n› hesaplayacak bir tahmin modelini formüle etmekti. Yöntem: Çal›flmaya 36-41 gebelik haftas›nda olan 96 nullipar gebe dahil edildi. Tüm olgular, flu dahil edilme kriterlerini karfl›l›yordu: canl› tekil gebelik, bafl prezentasyonu, zarar görmemifl amniyotik membran, vajinal do¤um için kontraendikasyonsuz aktif do¤umun olmamas›. Hastalar, 3 servikal ve 2 fetal bafl parametresinden oluflan ultrason skorumuzla de¤erlendirildi. Bu parametreler fetal bafl pozisyonu, fetal bafl-simfizis pubis mesafe iliflkisi, servikal uzunluk, kanallaflma ve posterior servikal aç›yd›. Her bir parametre, 0-2'den maksimum 10'a kadar puanland›. Sonografik bulgular için körlenmifl ikinci bir obstetrisyen modifiye Bishop skorunu de¤erlendirdi. ROC e¤ri noktalar› ve e¤ri alt›ndaki alan›n hesaplanmas› için SPSS 20 kullan›ld›. ‹kili lojistik regresyon modeli haz›rland› ve çeflitli skorlar için vajinal do¤um olas›l›¤› hesapland›. Bulgular: Doksan bir olgunun 61'i (%67) aktif do¤um evresine ula-fl›rken 54 (%59) olgu vajinal do¤um yapt›. Pelvik ultrason skorumuz, Bishop skoruna k›yasla daha iyi hassasiyet ve özgüllük sergiledi. ≥5'lik kesme de¤erinde ultrason skoru %79.3 hassasiyet ve %75.8 özgüllük de¤erine sahipken, bu de¤erler Bishop skorunda s›-ras›yla %66.7 ve %44.2'ydi. ‹kili lojistik regresyon modeli olaylar›n %78.0'›n› do¤ru flekilde tahmin etti. Sonuç: Çal›flmam›z, "Garg ultrason skorunun" nullipar kad›nlarda do¤um indiksiyonunun baflar›s›n› tahmin edebildi¤ini göstermektedir. Önerilen bu pelvik ultrason skoru, çok merkezli daha büyük çal›flmalarla do¤rulanmas› halinde, vajinal do¤um olas›l›¤›-n› tahmin etmede klinisyenlere kan›ta dayal› rehberlik sunabilir. Bu da do¤um indüksiyonu geçirmeden önce kad›nlar›n daha bilinçli bir karar vermesini sa¤layabilir.

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“…Another limitation relates to the fact that we did not evaluate the measurement of transperineal subpubic angle and fetal head circumference in our study. Both parameters have been shown to be useful in predicting unplanned operative delivery before IOL in nulliparous women [27,28].…”

Section: Discussionmentioning

confidence: 99%

Pre-Induction Transperineal Ultrasound Assessment for the Prediction of Labor Outcome

et al. 2018

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Objective: To examine (1) the concordance of manual and automated para-symphyseal angle of progression (psAOP) measurements, (2) the repeatability of psAOP, head-symphysis distance, head-perineum distance, and sonographic cervical dilatation, and (3) the value of transperineal ultrasound (TPU) in predicting induction of labor (IOL) outcome. Methods: We performed a prospective study in 308 women with singleton pregnancies undergoing IOL at term. Logistic regression analysis was used to determine which maternal factors, Bishop score, method of IOL, and TPU parameters were significant predictors of cesarean section (CS) and CS due to no progress (CS-NP). Results: There was vaginal delivery in 225 (83.0%) and CS in 46 (17.0%) cases. The intra-class correlation coefficient between manual and automated psAOP was 0.866, but automated psAOP was 4.6° wider than manual measurement. All TPU parameters had an inter-observer intra-class correlation coefficient > 0.800. Significant independent prediction of CS and CS-NP was provided by maternal factors, previous vaginal delivery, and psAOP. There was no improvement in area under the receiver-operating characteristic curve with the addition of psAOP to maternal factors. Conclusions: All TPU parameters are reproducible. Comparing the three TPU parameters for fetal head station, only psAOP is a significant independent predictor of CS; however, it is unlikely to be useful in predicting IOL outcome.

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Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery

Abstract: Ultrasound assessment of fetal HC and maternal SPA after 36 weeks of gestation can identify a subset of women at higher risk of UOD during labor, for whom early planned delivery might be beneficial.

Cited by 32 publications

References 22 publications

Correlation between Subpubic Arch Angle and Mode of Delivery in Large-for-Gestational-Age Fetuses

Correlation between Subpubic Arch Angle and Mode of Delivery in Large-for-Gestational-Age Fetuses

An ultrasound prediction model for probability of vaginal delivery in induction of labor

Pre-Induction Transperineal Ultrasound Assessment for the Prediction of Labor Outcome

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