Intrapartum ultrasound to predict vaginal labor: a prospective cohort study

Abstract

Background: Non-invasive transperineal ultrasound has been used to detect the descent of the fetal head using head-perineum distance (HPD) and angle of progression (AOP). The aim was to evaluate HPD and AOP as predictors of vaginal delivery in the first stage of labor.Methods: This was a prospective cohort study in Riga Maternity Hospital in Latvia from May till August 2016. The study included only nulliparous women with singleton pregnancies and cephalic presentation. Ultrasound was used to measure HPD and AOP. Data was collected on demographics, labor parameters and outcome.Results: Of 36 women enrolled, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve for the prediction of vaginal delivery was 0.865 (95% confidence interval (CI) 0.75-0.98) using HPD as the test variable and the area under the curve was 0.877 (95% CI 0.77-0.99) for AOP. The median HPD was lower in the women delivering vaginally than in the women delivering by cesarean section (P<0.001). HPD was ≤40 mm in 18 (50%) women, of whom all delivered vaginally. HPD was >40 mm in the other 18 women, of whom 8 (22.2%) delivered vaginally (P<0.001). AOP was ≥105° in 22 (61.1%) women and, of these, 21 delivered vaginally. AOP was <105° in the other 14 (38.9%) women, of whom 5 delivered vaginally (P<0.001).Conclusions: HPD ≤40 mm and AOP ≥105° are both predictive of vaginal delivery in the first stage of labor.

Accuracy of non-invasive methods for assessing the progress of labor in the first stage: a systematic review and meta-analysis

“…First, the aim of the paper was to achieve a synthesis of the sensitivity, specificity, positive predictive value, and negative predictive value, which may limit the analyses of the different research methods adopted. Next, in this review, there are eight studies from the same African country, and because there are different healthcare institutions, ultrasound systems and observers in conducting births may have contributed to the variability of the results [ 36 , 44 ]. Moreover, pelvic shapes and sizes differ with ethnicity, which may result in different results in the accuracy of labor assessment.…”

The Role of Intrapartum Ultrasound to Predict Outcome of Delivery

“…27 Were able to predict vaginal delivery during 1 st stage of labour dystocia with angle of progression <100 o (76% ROC/AUC) and head perineum distance >5 cm (81% ROC/ AUC) increase the chance of cesarean section. 28 Determined the predictive value of vaginal delivery are with angle of progression >105 o (87.7% ROC/AUC) and head perineum distance < 4 cm (86.5% ROC/AUC) 29 .…”

Intrapartum ultrasound in women with prolonged first stage of labor

“…37 HPD less than 40 mm in the first stage of active labor has also been confirmed by others as a cut-off for high chance of a vaginal delivery. 38 Hamilton et al studied the relation between clinically assessed cervical dilatation and head station and found a linear association, but an ultrasound study found that this association was not linear. 39 Fetal station was initially stable and accelerated during the last four hours in women ending with a spontaneous delivery.…”