Ultrasound in Labor and Delivery

Molina, Francisca S.; Nicolaides, Kypros H.

doi:10.1159/000287588

Cited by 74 publications

(51 citation statements)

References 45 publications

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“…However, there is much evidence that palpation performed during childbirth is inaccurate and does not allow for precise deter-mining the progression of head in the birth canal and that it is prone to a high number of errors in the evaluation of position and lie of the presenting part in both the first and second stage of labor [4].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery

Ciaciura-Jarno¹,

Cnota²,

Wójtowicz³

et al. 2016

Ginekol Pol

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Objectives: The aim of the study is to determine the usefulness of ultrasound parameters in the second stage of labor in prediction of the method of delivery and to evaluate the benefits to be derived from this study. Material and methods:Ultrasound scan was performed with Convex transabdominal probe on 68 pregnant women in labor at term with fetuses in cephalic presentation at the beginning of the second stage of labor and parameters such as angle of progression, head progression distance, head-symphysis distance and head-perineum distance were measured. The parameters were observed in two scans: a midline scan visualizing the pubic symphysis with the head of the fetus and a transverse scan approximately 1-2 cm below the pubic symphysis visualizing the head of the fetus. Results:The ultrasound parameters measured at the beginning of the second stage of labor, differed in the group in which women have delivered vaginally and in the group, in which caesarean section was performed: angle of progression and head progression distance were greater in group of women who delivered naturally and head-perineum distance and head-symphysis distance were smaller in this group. Some relations between each measured parameter and time left to delivery were observed as well as strong relations among parameters were also observed. Conclusions:Intrapartum sonography is a useful and objective tool to assess the progress of labor. Transperineal ultrasound scans performed in the second stage of labor may play a role in making the decision about the mode of delivery.

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Section: Introductionmentioning

confidence: 99%

“…Molina and Nicholaides write that intrapartum ultrasound may help evaluate whether pregnancy will end in a vaginal delivery and Ghi et al reports that the assessment of head progression in the birth canal during the second stage of labor may play a role in predicting the manner of delivery [4,11].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery

Ciaciura-Jarno¹,

Cnota²,

Wójtowicz³

et al. 2016

Ginekol Pol

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“…2 Akmal et al reported that digital VE failed to determine the fetal head position in 34% of laboring women, and incorrectly determined head position in 51% of patients in whom the position could be defined. 3,4 Digital VE are shown to be associated with infection ascending to the fetus, chorioamnionitis, endometritis and shortened time interval to delivery in preterm labor. 5,6 Digital VE have also been shown to frequently be experienced as painful and embarrassing to the women being examined.…”

Section: Introductionmentioning

confidence: 99%

Intrapartum ultrasound to predict vaginal labor: a prospective cohort study

Ingeberg¹,

Miskova²,

Andzane³

2017

Int J Reprod Contracept Obstet Gynecol

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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.

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“…HD. Finally, this parameter is quantified by measuring the direction angle (DA) between the IL and the HD 11,14 . In some studies 4,10 , HD is classified in this final step in relation to the SPla: 'head up' (when it points ventrally at an angle of > 30…”

mentioning

confidence: 99%

Quantification of fetal head direction using transperineal ultrasound: an easier approach

Iliescu

Adam

Tudorache

et al. 2012

Ultrasound in Obstet & Gyne

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Quantification of fetal head direction using transperineal ultrasound: an easier approachUltrasound offers several advantages for planning and monitoring labor, being a safe, non-invasive and easyto-learn technique, which offers accurate and objective information, even in difficult clinical situations. Several linear measurements (progression distance and head-toperineum distance) and angles (head direction (HD), progression angle and middle-line angle), have been shown to be useful in the estimation of fetal head progression 1 -10 . The rationale for assessing HD during the second stage of labor is the curvilinear path of fetal head descent, directed initially downward then horizontally and finally upward, that can be easily tracked in the sagittal transperineal view. Alone or in combination with other ultrasound parameters, HD has proved useful in the prediction of vaginal and successful operative delivery 4,10 . The abovementioned linear and angle assessments can be obtained in a semiautomatic manner, using threedimensional ultrasound 11 , but this is not widely available for use on the labor ward, requires additional skills to perform and has not been shown to provide further benefit over two-dimensional ultrasound 12 . Most of these linear distances and angles can be determined quickly and simply by measuring a single angle (progression angle, middle-line angle), a single distance (head-to-perineum distance) or a combination of a 90• angle and a line (progression distance). However, a recent systematic review 13 does not wholly support the use of ultrasound in labor and there is an argument that some measures are too complicated. For example, for quantification of HD, first the maternal reference parameter, the infrapubic line (IL), is drawn perpendicular to the symphysis pubis long axis (SPla), starting from the inferior symphyseal margin. Then the fetal parameter, the widest head diameter, is traced. Fetal head descent with respect to the pubic symphysis and IL is evaluated by drawing a line perpendicular to the widest diameter of the fetal head, i.e. HD. Finally, this parameter is quantified by measuring the direction angle (DA) between the IL and the HD 11,14 . In some studies 4,10 , HD is classified in this final step in relation to the SPla: 'head up' (when it points ventrally at an angle of > 30• ), 'head down' (when this angle is < 0 • ) and 'horizontal' (when this angle is 0-30• ). We propose an easier assessment of DA, by reducing the number of steps in the protocol. In Figure 1 we show how the classical measurement is equivalent to the angle between the fetal biparietal diameter and SPla. Thus, the steps described above can be substituted by the measurement of one angle between two lines similar, for example, to measurement of the fetal cardiac axis (Figure 2). Increasing values of this angle signify Figure 1 Classical fetal head direction angle (angle DA1), between infrapubic line (IL) and head direction (HD), is equal to angle between biparietal diameter (BPD) and symphysis pubis long axis (SP...

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Ultrasound in Labor and Delivery

Cited by 74 publications

References 45 publications

Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery

Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery

Intrapartum ultrasound to predict vaginal labor: a prospective cohort study

Quantification of fetal head direction using transperineal ultrasound: an easier approach

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