Automated Measurement of the Angle of Progression in Labor: A Feasibility and Reliability Study

Youssef, A.; Salsi, G.; Montaguti, Elisa; Bellussi, Federica; Pacella, G.; Azzarone, C.; Farina, Antonio; Rizzo, Nicola; Pilu, Gianluigi

doi:10.1159/000448947

Cited by 25 publications

(25 citation statements)

References 32 publications

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“…The sagittal method ICC for intraobserver reliability in our study was 0.93, which is within the range reported in previous studies of 0.90 to 0.98, while the ICC for interobserver reliability in our study was 0.74, which is just below the lower end of previously reported ranges of 0.77 to 0.95. On comparing methods, we found similar mean differences between the automated parasagittal approach and the sagittal approach (12° vs 15°) and a similar failure rate of the automated method (19% vs 15%) as in the study of Youssef et al …”

Section: Discussionsupporting

confidence: 87%

“…This problem has been partially addressed with the development of automated software (Sono L&D; GE Healthcare, Zipf, Austria) which uses a different set of landmarks, namely the more hyperechogenic pubic rami seen in a slightly parasagittal view (Figure ). A previous study assessing the automated technique found that it systematically overestimated AoP compared to the sagittal approach, but the study did not compare directly a manual parasagittal approach to the automated method. No previous study has evaluated a manual parasagittal approach in predicting time to delivery or operative delivery.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of different methods of measuring angle of progression in prediction of labor outcome

Frick

Kostiv

Vojtassakova

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives First, to compare the manual sagittal and parasagittal and automated parasagittal methods of measuring the angle of progression (AoP) by transperineal ultrasound during labor, and, second, to develop models for the prediction of time to delivery and need for Cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor. Methods This was a prospective observational study of transperineal ultrasound in a cohort of 512 women with a singleton pregnancy undergoing induction of labor. A random selection of 50 stored images was assessed for inter‐ and intraobserver reliability of AoP measurements using the manual sagittal and parasagittal and automated parasagittal methods. In cases of vaginal delivery, univariate linear, multiple linear and quantile regression analyses were performed to predict time to delivery. Univariate and multivariate binomial logistic regression analyses were performed to predict CS for FTP in the first stage of labor. Results The intraclass correlation coefficient (ICC) for the manual parasagittal method for a single observer was 0.97 (95% CI, 0.95–0.98) and for two observers it was 0.96 (95% CI, 0.93–0.98), indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (95% CI, 0.88–0.96) and for two observers it was 0.74 (95% CI, 0.58–0.84), indicating moderate reliability for a single observer and poor reliability between two observers. Bland–Altman analysis demonstrated narrower limits of agreement for the manual parasagittal approach than for the sagittal approach for both a single and two observers. The automated parasagittal method failed to capture an image in 19% of cases. The mean difference in AoP measurements between the sagittal and manual parasagittal methods was 11°. In pregnancies resulting in vaginal delivery, 54% of the variation in time to delivery was explained in a model combining parity, epidural and syntocinon use during labor and the sonographic findings of fetal head position and AoP. In the prediction of CS for FTP in the first stage of labor, a model which combined maternal factors with the sonographic measurements of AoP and estimated fetal weight was superior to one utilizing maternal factors alone (area under the receiver‐operating‐characteristics curve, 0.80 vs 0.76). Conclusions First, the method of measuring AoP with the greatest reliability is the manual parasagittal technique and future research should focus on this technique. Second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings. Third, the ability of AoP to provide clinically useful prediction of CS for FTP in the first stage of labor is limited. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Frick

Kostiv

Vojtassakova

et al. 2020

Ultrasound in Obstet & Gyne

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“…The finding that the HSD does not remain as an independent predictor of labor outcome is primarily related to its significant correlation with psAOP. The findings that the measurements of manual and automated psAOP have good inter-observer agreement and repeatability, and that psAOP measured by the automated technique is wider than that derived from the manual technique, are in keeping with a recent publication by Youssef et al [25] suggesting that the automated process requires further improvement and optimization with the use of the symphysis pubis. We also demonstrated the feasibility and repeatability of the measurement of SCD.…”

Section: Discussionsupporting

confidence: 84%

Pre-Induction Transperineal Ultrasound Assessment for the Prediction of Labor Outcome

et al. 2018

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Objective: To examine (1) the concordance of manual and automated para-symphyseal angle of progression (psAOP) measurements, (2) the repeatability of psAOP, head-symphysis distance, head-perineum distance, and sonographic cervical dilatation, and (3) the value of transperineal ultrasound (TPU) in predicting induction of labor (IOL) outcome. Methods: We performed a prospective study in 308 women with singleton pregnancies undergoing IOL at term. Logistic regression analysis was used to determine which maternal factors, Bishop score, method of IOL, and TPU parameters were significant predictors of cesarean section (CS) and CS due to no progress (CS-NP). Results: There was vaginal delivery in 225 (83.0%) and CS in 46 (17.0%) cases. The intra-class correlation coefficient between manual and automated psAOP was 0.866, but automated psAOP was 4.6° wider than manual measurement. All TPU parameters had an inter-observer intra-class correlation coefficient > 0.800. Significant independent prediction of CS and CS-NP was provided by maternal factors, previous vaginal delivery, and psAOP. There was no improvement in area under the receiver-operating characteristic curve with the addition of psAOP to maternal factors. Conclusions: All TPU parameters are reproducible. Comparing the three TPU parameters for fetal head station, only psAOP is a significant independent predictor of CS; however, it is unlikely to be useful in predicting IOL outcome.

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“…The fetal head–symphysis distance ( E and F ) is the distance between the lowest edge of the pubic symphysis and the nearest point of the fetal skull along a line passing perpendicular to the long axis of PS and tangential to its lower border (reproduced from Youssef et al with permission). 67 , 87 …”

Section: Figurementioning

confidence: 99%

Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects

Salsi¹,

Cataneo²,

Dodaro³

et al. 2017

IJWH

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During the last decade, there has been a huge advancement in the use of transperineal ultrasound (TPU) in the field of obstetrics and gynecology. Its main applications in obstetrics include the monitoring of fetal progression in labor and recently the assessment of maternal pelvic dimensions, whereas in gynecology, TPU is at present widely used for the evaluation of the female pelvic floor, opening new boundaries for the assessment of pelvic floor disorders. The association of volumetric three-dimensional techniques has largely contributed to the remarkable progress that has occurred in the use of TPU. The aim of this paper is to offer an overview of the advantages, challenges and future perspectives of the use of TPU for women’s imaging.

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Automated Measurement of the Angle of Progression in Labor: A Feasibility and Reliability Study

Cited by 25 publications

References 32 publications

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Pre-Induction Transperineal Ultrasound Assessment for the Prediction of Labor Outcome

Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects

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