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Sonographic prediction of vaginal delivery in prolonged labor: a two-center study

Eggebo, T. M.; Hassan, W. A.; Salvesen, Kjell LU ; Lindtjorn, E. and Lees, C. C. (2014) In Ultrasound in Obstetrics & Gynecology 43(2). p.195-201
Abstract
Objective To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). Methods This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line... (More)
Objective To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). Methods This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. Results Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was <= 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was >40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was >= 110 degrees in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was <110 degrees in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD <= 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP >= 110 degrees (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. Conclusion Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor. Copyright (C) 2013 ISUOG. Published by John Wiley & Sons Ltd. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
angle of progression, Cesarean section, head-perineum distance, occiput, posterior position
in
Ultrasound in Obstetrics & Gynecology
volume
43
issue
2
pages
195 - 201
publisher
John Wiley & Sons
external identifiers
  • wos:000331242400013
  • scopus:84893740970
ISSN
1469-0705
DOI
10.1002/uog.13210
language
English
LU publication?
yes
id
1ede16c0-8445-45a2-a804-63103a5f8b11 (old id 4418953)
date added to LUP
2014-05-05 07:21:50
date last changed
2017-10-22 03:58:29
@article{1ede16c0-8445-45a2-a804-63103a5f8b11,
  abstract     = {Objective To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). Methods This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. Results Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was &lt;= 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was &gt;40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was &gt;= 110 degrees in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was &lt;110 degrees in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD &lt;= 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP &gt;= 110 degrees (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. Conclusion Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor. Copyright (C) 2013 ISUOG. Published by John Wiley &amp; Sons Ltd.},
  author       = {Eggebo, T. M. and Hassan, W. A. and Salvesen, Kjell and Lindtjorn, E. and Lees, C. C.},
  issn         = {1469-0705},
  keyword      = {angle of progression,Cesarean section,head-perineum distance,occiput,posterior position},
  language     = {eng},
  number       = {2},
  pages        = {195--201},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {Sonographic prediction of vaginal delivery in prolonged labor: a two-center study},
  url          = {http://dx.doi.org/10.1002/uog.13210},
  volume       = {43},
  year         = {2014},
}