Objective: The aim of the study was to evaluate the dynamic changes of angle of progression (AoP) before the onset of labor and their correlation with labor outcome and to investigate the effect of visual feedback using transperineal ultrasound on maternal pushing. Methods: We recruited a group of low-risk nulliparous women with singleton pregnancy at term. We measured AoP at rest, during pelvic floor contraction and Valsalva maneuver (before and after visual feedback). We compared AoP between women who delivered vaginally (VD) and those who underwent a cesarean section (CS). We also assessed the correlation between AoP and labor durations. Results: Overall, 222 women were included in the study; 129 (58.1%) had spontaneous VD, 35 (15.8%) had instrumental delivery, and 58 (26.1%) underwent CS. In comparison with rest, AoP decreased at PFMC (p < .001) and increased at first Valsalva (p < .001). AoP increased further significantly at Valsalva after visual feedback (p < .001). Women with VD had wider AoP at rest (p ¼ .020), during Valsalva maneuver before (p ¼ .024), and after visual feedback (p ¼ .037). At cox regression analysis, wider AoP was associated with shorter first, second, and active second stages. Conclusion: Wider AoP at rest and under Valsalva is associated with vaginal delivery, the shorter interval to delivery, and shorter labor duration in nulliparous women at term. The accuracy of AoP in the prediction of cesarean delivery is modest and is unlikely to be clinically applicable in isolation for the prediction of the mode of delivery.
Aim Lung ultrasound (LUS) is a reliable, radiation-free, and bedside imaging technique used to assess several pulmonary diseases. Although COVID-19 is diagnosed with a nasopharyngeal swab, detection of pulmonary involvement is crucial for safe patient discharge. Computed tomography (CT) is currently the gold standard. To treat paucisymptomatic patients, we have implemented a “fast track” pathway in our emergency department, using LUS as a valid alternative. Minimal data is available in the literature about interobserver reliability and the level of expertise needed to perform a reliable examination. Our aim was to assess these.
Materials and Methods This was a single-center prospective study. We enrolled 96 patients. 12 lung areas were explored in each patient with a semiquantitative assessment of pulmonary aeration loss in order to obtain the LUS score. Scans were performed by two different operators, an expert and a novice, who were blinded to their colleague’s results.
Results 96 patients were enrolled. The intraclass correlation coefficient (ICC) showed excellent agreement between the expert and the novice operator (ICC 0.975; 0.962–0.983); demographic features (age, sex, and chronic pulmonary disease) did not influence the reproducibility of the method. The ICC was 0.973 (0.950–0.986) in males, 0.976 (0.959–0.986) in females; 0.965 (0.940–0.980) in younger patients (≤ 46 yrs), and 0.973 (0.952–0.985) in older (> 46 yrs) patients. The ICC was 0.967 (0.882–0.991) in patients with pulmonary disease and 0.975 (0.962–0.984) in the other patients. The learning curve showed an increase in interobserver agreement.
Conclusion Our results confirm the feasibility and reproducibility of the method among operators with different levels of expertise, with a rapid learning curve.
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