Document Detail

Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the 'angle of progression' predict the mode of delivery?
MedLine Citation:
PMID:  19224527     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To compare the angle of progression on transperineal ultrasound imaging between different modes of delivery in prolonged second stage of labor with occipitoanterior fetal position. METHODS: We prospectively evaluated 41 women at term (>or= 37 weeks) with failure to progress in the second stage of labor. Only cases with occipitoanterior fetal position were included in the final analysis. These cases were classified into three groups: Cesarean section for failure to progress, vacuum extraction for failure to progress, and spontaneous delivery following prolonged second stage of labor. Transperineal ultrasound examination was performed just before digital examination and subsequent delivery. The angle between a line placed through the midline of the pubic symphysis and a line running from the inferior apex of the symphysis tangentially to the fetal skull (the so-called 'angle of progression') was measured offline by an observer blinded to the mode of delivery. RESULTS: There were 26 cases with occipitoanterior fetal position (Cesarean section, n = 5; vacuum extraction, n = 16; spontaneous delivery, n = 5). Logistic regression analysis showed a strong relationship between the angle of progression and the need for Cesarean delivery (R(2) measure of fit = 55%, likelihood ratio chi-square P < 0.0001). When the angle of progression was 120 degrees , the fitted probability of either an easy and successful vacuum extraction or spontaneous vaginal delivery was 90%. CONCLUSIONS: This is the first report to document a strong relationship between an objective ultrasound marker (angle of progression) and the mode of delivery following prolonged second stage of labor with occipitoanterior fetal position. A predictive model using this parameter would allow better decision making regarding operative delivery for obstructed labor.
K D Kalache; A M D??ckelmann; S A M Michaelis; J Lange; G Cichon; J W Dudenhausen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  33     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-04     Completed Date:  2010-02-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  326-30     Citation Subset:  IM    
Copyright Information:
(c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Department of Obstetrics, Charit?? University Hospital, Campus Benjamin Franklin, Berlin, Germany.
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MeSH Terms
Delivery, Obstetric / methods*
Head / embryology,  ultrasonography*
Labor Presentation*
Labor Stage, Second*
Obstetric Labor Complications / prevention & control,  ultrasonography*
Perineum / ultrasonography*
Predictive Value of Tests
Pregnancy Outcome
Ultrasonography, Prenatal / methods
Comment In:
Ultrasound Obstet Gynecol. 2009 Dec;34(6):735   [PMID:  19953562 ]
Ultrasound Obstet Gynecol. 2009 Jun;33(6):735; author reply 736   [PMID:  19434619 ]

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