ISUOG Practice Guidelines: intrapartum ultrasound

Ghi, T.; Eggebø, Torbjørn Moe; Lees, C.; Kalache, Karim; Rozenberg, Patrick; Youssef, A.; Salomon, Laurent; Tutschek, B.

doi:10.1002/uog.19072

Cited by 236 publications

(208 citation statements)

References 100 publications

(228 reference statements)

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“…37,38 Most studies agree that, although vacuum deliveries do not increase the rate of levator ani muscle injuries, the use of forceps is one of the most important risk factors for the appearance of these kinds of lesions. 39 In fact, some authors argue that this increase in the use of forceps will cause an increase in the maternal morbidity rate. 23 However, evaluations based on a single obstetric parameter, the cesarean section rate, should not be the objective of assessing the general obstetric performance of a hospital.…”

Section: Malmström Vacuum and Kielland Forceps Deliveriesmentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: CI, confidence interval; LAM, levator ani muscle; OR, odds ratio. AbstractIntroduction: Forceps delivery is associated with a high rate of levator ani muscle (LAM) trauma (avulsion) at 35%-65% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and LAM avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of LAM avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation. Material and methods: Prospective, observational study, including 263 nulliparous women, who underwent an instrumental delivery with either Malmström vacuum or Kielland forceps. The characteristics of the instrumentation, position (anterior position and other position) and height of the fetal head at the moment of instrumentation (low instrumentation [vertex at +2 station] and mid-instrumentation [head isinvolved but leading part above +2 station]) were assessed. Evaluation of LAM avulsion was performed at 6 months postpartum by three-/four-dimensional transperineal ultrasound. Using the multi-view mode, a complete avulsion was diagnosed when the abnormal muscle insertion was identified in all three central slices, that is, in the plane of minimal hiatal dimensions and the 2.5-mm and 5.0-mm slices cranial to this one. To detect a 30% or 15% difference in the LAM injury rate, with 80% power and 5% α-error, we needed, respectively 42 and 99 women per study group.Results: In all, 263 nulliparous individuals have been evaluated (162 vacuum deliveries, 101 forceps deliveries). Instrumentation in an occipito-anterior position was more frequent in vacuum deliveries (75.3% vs 56.4%, P = .002), whereas other positions were more frequent in the forceps deliveries group (24.7% vs 43.6%). No statistically significant differences were noted regarding the height of the fetal head at the moment of instrumentation. No statistically significant differences were found in the presence of LAM avulsion (41.4% vs 38.6%) between vacuum and forceps deliveries.The univariate analysis of the crude odds ratio was 1.17, 95% CI 0.67-1.98, P = .70 for

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Section: Malmström Vacuum and Kielland Forceps Deliveriesmentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

et al. 2019

Acta Obstet Gynecol Scand

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“…Both transabdominal and transperineal images in the sagittal and transverse planes were obtained. Position of the fetus was determined by location of the fetal spine, orbits and midline intracranial structures (Figure ). The amount of caput succedaneum and molding was assessed sonographically (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…To be considered correct, the fetal head position reported by the resident had to be within 15° of the ultrasound‐determined position. Fetal occipital head position was defined using clock‐face terminology as: occiput anterior from > 09:30 h to < 02:30 h; occiput posterior from > 03:30 h to < 08:30 h; and right and left occiput transverse from > 08:30 h to < 09:30 h and > 02:30 h to < 03:30 h, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…To be considered correct, the fetal head position reported by the resident had to be within 15 • of the ultrasound-determined position. Fetal occipital head position was defined using clock-face terminology as: occiput anterior from > 09:30 h to < 02:30 h; occiput posterior from > 03:30 h to < 08:30 h; and right and left occiput transverse from > 08:30 h to < 09:30 h and > 02:30 h to < 03:30 h, respectively15 .The training intervention consisted of demonstrating to the resident the actual fetal position and the expected location of fontanelles, sutures and ears, using immediate ultrasound feedback and pictorial education, followed by the resident performing a repeat vaginal examination if the initial one was inaccurate. Each of the six third-year residents underwent a blinded baseline evaluation (15 examinations), training intervention (20 examinations) Transperineal ultrasound image in sagittal view of fetal head demonstrating molding of sutures and presence of caput succedaneum.…”

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confidence: 99%

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Ultrasound feedback training increases trainee accuracy in vaginal assessment of fetal head position in labor

Goldkamp

Vricella

Mostello

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To evaluate the impact of an immediate ultrasound feedback intervention on trainee accuracy in vaginal‐examination‐based assessment of fetal head position. Methods This was a prospective cohort study conducted at a single tertiary care center. Six third‐year and six fourth‐year residents in an obstetrics and gynecology residency training program were the study subjects. The third‐year residents underwent a training intervention in which they assessed fetal head position by transvaginal digital examination and then received immediate feedback through ultrasound demonstration of the actual position. All examinations were performed in women with a singleton gestation ≥ 35 weeks and cervical dilation ≥ 8 cm, following rupture of membranes. The comparison groups were third‐year residents before, during and after training and fourth‐year residents who were not exposed to the training intervention. The primary outcome was the difference in accuracy of fetal‐head‐position assessment on vaginal examination by third‐year residents before and after ultrasound feedback training. Univariate and multivariate analyses were performed to identify factors associated with digital examination accuracy. Results Overall, 390 examinations were performed. The accuracy of fetal‐head‐position assessments of third‐year residents was 55% (53/96) before training, 65% (74/114) during training and 70% (63/90) after training, while that of fourth‐year residents who did not undergo training was 52% (47/90) (P = 0.04). Fourth‐year residents who did not undergo ultrasound training demonstrated similar baseline accuracy to that of third‐year residents pretraining (52% (47/90) vs 55% (53/96), P = 0.68), but had significantly lower accuracy than had the third‐year residents post‐training (52% (47/90) vs 70% (63/90); P = 0.01). Multivariable analysis revealed a positive association between ultrasound feedback training and the ability to assess accurately fetal head position. After adjusting for the variables included in the final model, examinations performed by third‐year residents pretraining and those performed by fourth‐year residents who did not undergo training were less likely to be accurate than those performed by third‐year residents post‐training (adjusted odds ratio, 0.48 (95% CI, 0.26–0.91) and 0.42 (95% CI, 0.22–0.80), respectively). Conclusion Immediate ultrasound feedback training increased trainee accuracy in vaginal assessment of fetal head position in labor. Its integration into obstetric training programs should be considered. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…A number of new techniques have been described using transperineal ultrasound to monitor labor progress through measurements relating fetal head position to the maternal pelvis 12,13 . These techniques are non-invasive, are well tolerated by patients and have a high degree of inter-and intraobserver reliability 8,[14][15][16][17][18][19][20][21][22][23] . The most widely studied measurement is that of the angle of progression (AoP), which is the angle between the leading part of the fetal skull and the maternal pubic symphysis 13 .…”

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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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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ISUOG Practice Guidelines: intrapartum ultrasound

Cited by 236 publications

References 100 publications

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

Ultrasound feedback training increases trainee accuracy in vaginal assessment of fetal head position in labor

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

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