Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal Delivery

Bibbo, Carolina; Rouse, Caroline E.; Cantonwine, David E.; Little, Sarah E; McElrath, Thomas F.; Robinson, Julian N.

doi:10.1055/s-0037-1608633

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…The fetal head in both models started at an angle of progression of 1008, but at the moment of fetal head crowningdefined here as the point of maximum perineal body strain, as in previous studies-the Included Model had a larger value [20,21,25]. The superficial perineal structures increased the final fetal head angle of progression, indicating that the soft tissues in the Included Model were pushed further to reach an analogous moment of fetal head crowning.…”

Section: Discussionsupporting

confidence: 64%

“…Angle of progression is a twodimensional angle between the midsagittal, long (or semi-major) axis of the ellipse-shaped pubic symphysis and a line connecting royalsocietypublishing.org/journal/rsfs Interface Focus 9: 20190011 the inferior end of this axis to the vertex of the fetal skull measured at approximately the midsagittal plane [20,21]. This has been shown to be a more reliable, robust method for measuring fetal head progression during vaginal delivery and easier to define within a finite-element model than fetal head stations [20,21]. In this study, the concept of the angle of progression was also applied to the perineal body, where the first line is still the long axis of the pubic symphysis but the second extends to the centroid of the perineal body instead of the fetal head.…”

Section: Discussionmentioning

confidence: 99%

“…Using these displacements, the angle of progression was calculated at each available time point for both models from the onset of the second stage of labour (t ¼ 0 in these simulations) to fetal head crowning (defined as the instant of maximum perineal body strain). Angle of progression is a twodimensional angle between the midsagittal, long (or semi-major) axis of the ellipse-shaped pubic symphysis and a line connecting royalsocietypublishing.org/journal/rsfs Interface Focus 9: 20190011 the inferior end of this axis to the vertex of the fetal skull measured at approximately the midsagittal plane [20,21]. This has been shown to be a more reliable, robust method for measuring fetal head progression during vaginal delivery and easier to define within a finite-element model than fetal head stations [20,21].…”

Section: Discussionmentioning

confidence: 99%

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Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

et al. 2019

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This study's aim was to determine whether the inclusion of superficial perineal structures in a finite-element simulation of vaginal delivery impacts the pubovisceral muscle and perineal body, two common sites of birth-related injury. The hypothesis, inferred from prevailing literature, was that these structures would have minimal influence (differences less than ±10%). Two models were made using the Visible Human Project's female cadaver to create a rigid, fixed pelvis, musculature held by spring attachments to that pelvis, and a rigid, ellipsoidal fetal head prescribed with an inferior displacement to simulate delivery. Injury site stretch ratios and fetal head and perineal body displacements and angles of progression were compared between the Omitted Model (which excluded the superficial perineal structures as is common practice) and the Included Model (which included them). Included Model stretch ratios were +107%, −9.84% and −14.6% compared to Omitted Model perineal body and right and left pubovisceral muscles, respectively. Included Model peak perineal body inferior displacement was +72.5% greater while similar anterior–posterior displacements took longer to reach. These results refute our hypothesis, suggesting superficial perineal structures impact simulations of vaginal delivery by inhibiting perineal body anterior–posterior displacement, which stretches and inferiorly displaces the perineal body.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

et al. 2019

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“…Natural log of time to normal spontaneous delivery in the subgroup of primiparous women shows the highest association with HPD and AOP during uterine contraction (r = 0.742), making delivery time prediction comparable to utilising cervical dilatation. The AoP detected by transperineal ultrasound at the start of the second stage, according to Rouse et al (2017) [20] , may be able to predict the delivery method. A narrow AoP <153 degrees at complete cervical dilatation increased the likelihood of a prolonged second stage of labour and the need for a surgical delivery in pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the angle of progression and head-perineum distance in the prediction of type of delivery and duration of second stage of labor using intrapartum transperineal ultrasonography

Abdelfattah¹,

Ghorab²,

Hussien³

et al. 2023

Int. J. Clin. Obstet. Gynaecol.

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Background: Each pregnancy's straightforward goal is to deliver a healthy baby to a healthy mother. Prolonged second stages of labour have been linked to poor mother and neonatal outcomes. The gold standard for diagnosing head descent clinically is still a digital transvaginal examination. Head station is based on the relationship between the ischial spine and the leading edge of the foetal head in the maternal pelvis. The intrapartum transperineal ultrasonography is a safe method for determining the position of the foetal head and for anticipating the course of the delivery. It is very useful in analyzing phenomena connected to the transit of the foetus through the birth canal. Aims: This study's objective is to assess the effectiveness of intrapartum transperineal ultrasound in predicting the kind of birth and length of the second stage of labour by assessing parameters for the Angel of Progression and Head Perineum Distance. Patients and Methods: Cross-sectional prospective research is the study's design. At Tanta University Hospitals' Department of Obstetrics inpatient ward, 65 primigravida women participated in the study. commenced in August 2021 and concluded in August 2022. Results: According to our findings, there was a positive highly statistically significant correlation between AOP and vaginal delivery patients compared to CS delivery patients, while there was a negative highly statistically significant correlation between HPD and vaginal delivery patients compared to CS delivery patients. A positive highly statistically significant association was found between the length of the second stage and the HPD, while a negative highly statistically significant correlation was found between the length of the second stage and the angle of progression. Conclusion: Intrapartum ultrasound has been used to measure a number of characteristics, including the angle of progression (AOP) and head-perineum distance (HPD). The manner of delivery and length of pushing can be predicted with the help of an ultrasound conducted at the start of the active second stage of labour.

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“…According to the findings of Kameyama et al (30), trans-perineal ultrasonography examination shortly after complete cervical dilation was a useful predictor for predicting birth type. Bibbo et al (31) looked at the link between the angle of advancement determined by trans-peritoneal ultrasonography, the route of delivery, and the duration of the 2 nd stage in 137 patients. This study revealed that a progression angle of fewer than 153 degrees is linked to a higher risk of a prolonged pregnancy culminating in cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Angle of progression with trans-perineal ultrasound and delivery type in labor’s second stage; a cross-sectional study in Isfahan, Iran

2021

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Introduction: Numerous studies have shown that clinical evaluation in labor is not very accurate, therefore ultrasound is one of the instruments that can give us a more objective assessment than the clinical evaluation. Objectives: In this study, we investigate the magnitude of the angle of progression (AoP) at the second stage of labor in fetuses with cephalic presentation and its relation to spontaneous vaginal delivery. Patients and Methods: In this cross-sectional study, we measured the AoP using trans-perineal sonography in the 2nd stage of the labor and compared AoP in normal vaginal delivery (NVD), cesarean and NVD with vacuum groups on 80 pregnant women. We also investigated the correlation between AoP and induction time and duration of the second stage of labor. Results: In 80 study patients, 54 (67.5 %) had normal vaginal deliveries, 21 (26.2 %) had cesarean section and 5 (6.2%) had NVD with a vacuum. There was a statistically significant difference between NVD, cesarean section, and NVD with vacuum in terms of the AoP (P<0.01). There was a statistically significant correlation between AoP and induction time, duration of 2nd stage of labor and Apgar scores (P<0.05). Conclusion: Higher progression angle is associated with shorter induction time and 2nd stage of labor, higher neonatal Apgar scores and a higher chance of spontaneous vaginal delivery which makes it an appropriate index for predicting pregnancy outcomes.

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Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal Delivery

Abstract: The AoP has the potential to predict spontaneous vaginal delivery and the duration of the second stage of labor which may be useful in counseling patients and managing their labor.

Cited by 12 publications

References 21 publications

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

Assessment of the angle of progression and head-perineum distance in the prediction of type of delivery and duration of second stage of labor using intrapartum transperineal ultrasonography

Angle of progression with trans-perineal ultrasound and delivery type in labor’s second stage; a cross-sectional study in Isfahan, Iran

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