Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery

Abstract

Objectives: The aim of the study is to determine the usefulness of ultrasound parameters in the second stage of labor in prediction of the method of delivery and to evaluate the benefits to be derived from this study. Material and methods:Ultrasound scan was performed with Convex transabdominal probe on 68 pregnant women in labor at term with fetuses in cephalic presentation at the beginning of the second stage of labor and parameters such as angle of progression, head progression distance, head-symphysis distance and head-perineum distance were measured. The parameters were observed in two scans: a midline scan visualizing the pubic symphysis with the head of the fetus and a transverse scan approximately 1-2 cm below the pubic symphysis visualizing the head of the fetus. Results:The ultrasound parameters measured at the beginning of the second stage of labor, differed in the group in which women have delivered vaginally and in the group, in which caesarean section was performed: angle of progression and head progression distance were greater in group of women who delivered naturally and head-perineum distance and head-symphysis distance were smaller in this group. Some relations between each measured parameter and time left to delivery were observed as well as strong relations among parameters were also observed. Conclusions:Intrapartum sonography is a useful and objective tool to assess the progress of labor. Transperineal ultrasound scans performed in the second stage of labor may play a role in making the decision about the mode of delivery.

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

“…18 Ciaciura-Jarno et al reported that, at full dilation, all patients with an AoP above 126 degrees had a vaginal delivery. 19 Two other studies, published in 2009, reported on the association of AoP in the second stage with mode of delivery; however, the timing of the measurement of AoP was different to our study, making it difficult to compare their findings to our results. Barbera et al found that during the second stage (timing not specified), an angle of 120 degrees was predictive of spontaneous delivery in a small series of nulliparous and multiparous women.…”

“…11 Prior studies also analyzed the AoP at the full cervical dilation and its association with mode of delivery but their patient population included both nulliparous and multiparous women. [17][18][19] Marsoosi et al found that an AoP 113 degrees at the beginning of the second stage was associated with a 90.8% probability of vaginal delivery (including vacuum). 17 Kameyama et al demonstrated that the optimum cutoff AoP to predict spontaneous vaginal delivery at full cervical dilatation was 146 degrees.…”

Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

“…The angle greater than 120º-126º was associated with vaginal delivery in many publications. 3,9 In present study, authors found that the shorter HPD and the wider AOP correlated with the higher the possibility of vaginal delivery both in nulliparous and multiparous women. Sainz et al showed that women with the greater AOP gave vacuum-assisted delivery more easily.…”

Automatic ultrasound technique to measure angle of progression during labor

“…The recent literature includes reports on many sonographic approaches dedicated to quantitative monitoring of labor. However, their routine clinical application is typically hindered, either by the necessity for significant operator–machine interaction, or by the invasiveness associated with the employment of specific devices, which can cause discomfort for the patient and risk of lesion or infection.…”

“…Evaluation of AoP distal during the second stage of labor is a widely reported method to predict the mode of delivery. Ciaciura‐Jarno et al . analyzed AoP distal by performing transperineal ultrasound scans on 68 parturients and found a good correlation between greater AoP distal values and the natural delivery.…”