Fetal head descent assessed by transabdominal ultrasound: a prospective observational study

Kamel, Rasha; Negm, Sherif; Kahrs, B.H.; Eggebø, T. M.; Iversen, J.K.

doi:10.1016/j.ajog.2021.07.030

Cited by 5 publications

(3 citation statements)

References 53 publications

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“…We did not use a calculation or line-based system to analyze images. Other publications describe an infrapubic or suprapubic line for birth descent orientation [ 30 , 31 ]. Sometimes, when the transducer is placed perpendicular strictly on the symphysis, fetal indicators for descent are not displayed and it is necessary to shift the transducer onto the pubic crest.…”

Section: Discussionmentioning

confidence: 99%

Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study

Jennewein

Heemann

Hoock

et al. 2023

Arch Gynecol Obstet

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Purpose In order to spread competence in vaginal breech deliveries, it is necessary to develop new and easily applicable tools for birth progression and safety evaluation. Ultrasound is a useful and ubiquitously available tool with already documented value for birth progression observation. In deliveries out of breech presentation, an established ultrasound examination is missing. We determined the descent of the fetal buttocks in relation to the maternal pelvic inlet using intrapartum ultrasound. We evaluated these results in comparison to the clinical vaginal examination with the aim to establish an easily applicable method for birth outcome prediction. Therefore, we analyzed the predictive value of our examinations on birth outcome parameters, such as cesarean section rate, as well as fetal and maternal outcome parameters. Methods We performed a prospective blinded study on 106 mothers with vaginally intended breech delivery. At beginning of stage two in labor, the descent of the fetal buttocks into the mother’s pelvic inlet was detected with transabdominal ultrasound and vaginal examination by different observers. Primary outcome variable: Cesarean section rate. Secondary outcome variables: rate of manual assistance in vaginal deliveries, birth duration, 5′ APGAR score, umbilical arterial pH, maternal blood loss, and perineal injury. For non-parametric values, Wilcoxon’s χ2 test was performed. In order to analyze the predictive value of our examination, lack-of-fit analysis was conducted. Reliability evaluation of the sonographic examination was done with a matched-pair analysis. Results Women with positive intrapartum ultrasound breech engagement sign (+ IPUBES) had a significantly lower rate of cesarean section in comparison with those with negative IPUBES (5/67; 7.5% vs. 18/39; 46.2%; p < 0.0001). The area under the ROC curve for the prediction of CS for negative IPUBES was 0.765 with a sensitivity of 78.3% and a specificity of 74.7%. Sonographic examination showed an excellent reliability in a matched-pair analysis comparing vaginal and sonographic examinations with a mean difference of 0.012 (SD ± 0.027, 95% CI − 0.014 to 0.065). Mean birth duration was significantly longer in deliveries with negative IPUBES (533 min vs. 440 min; p = 0.0011). Fetal and maternal outcome parameters were not significantly different between deliveries with positive and negative IPUBES. Conclusions Sonographic evaluation of the fetal descent in relation to the mother’s pelvic inlet screens reliably for emergency cesarean section. This newly presented method for birth progression observation might be a powerful tool for distribution of expertise in vaginal breech delivery and is able to give reference for clinical vaginal examination by obstetricians in training. Trail registry Clinical trial. Date of registration: 13.03.2019; Date of initial participant enrollment: 20.03.2019; DRKS00016885; https://www.drks.de; German clinical trials register.

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Section: Discussionmentioning

confidence: 99%

Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study

Jennewein

Heemann

Hoock

et al. 2023

Arch Gynecol Obstet

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“…Fetal presentation was determined by ultrasound before the onset of active labor 12 and confirmed at birth of the second twin. Fetal presentation was categorized into the following two groups: vertex‐vertex (VV) presentation and vertex‐breech (VB) presentation.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of vertex‐vertex vs. vertex‐breech presentation in twin pregnancy after vaginal delivery in China

Liu

Yan

et al. 2023

Birth

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ObjectiveTo compare the maternal and neonatal outcomes of twin pregnancies between vertex and nonvertex presentations of the second twin in vaginal delivery.MethodsIn this unicentric retrospective cohort study, we collected data from 213 cases of vaginal twin deliveries from January 2016 to July 2020. Participants were divided into the vertex‐vertex presentation group (VV) and vertex‐breech presentation group (VB). Data on maternal and neonatal outcomes were compared between groups.ResultsAmong the 213 mothers and 426 infants (213 twin pairs), there were 140 women in the VV group and 73 women in the VB group (65.73% vs. 34.27%). Infants in the VB group had a higher incidence of admission to NICU (51.43% vs. 68.49%, p = 0.017), lower 1‐min (11.43% vs. 28.77%, p < 0.001) and 5‐minute Apgar scores (1.43% vs. 4.11%, p = 0.043) for the second twin. However, after the adjustment for sex of the twin, birth weight, chorionicity, and gestational age, the greater risk of admission to NICU and low 5‐min Apgar score was no longer significantly different.ConclusionVB twins are at no greater overall risk of a poor outcome due to breech presentation in the second twin. However, the presentation of the second fetus represents a risk factor for a low 1‐min Apgar score. Obstetricians and midwives should consider appropriate interventions for second twins who present breech versus vertex.

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“…Other methods suggested to evaluate labour progress during the second stage are assessment of maternal behaviour, abdominal palpitation (9), assessment of descent by ultrasound (9,16) and using the Pinard stethoscope (17).…”

Section: Vaginal Examinationsmentioning

confidence: 99%

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

Bjelke

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Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences. Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”. Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support.

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Fetal head descent assessed by transabdominal ultrasound: a prospective observational study

Cited by 5 publications

References 53 publications

Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study

Sonographic examination at the beginning of the second stage of labor predicts birth outcome in vaginally intended breech deliveries: a blinded prospective study

Outcomes of vertex‐vertex vs. vertex‐breech presentation in twin pregnancy after vaginal delivery in China

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

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