Pubic arch angle in prolonged second stage of labor: clinical significance

Gilboa, Yinon; Kivilevitch, Z.; Spira, Micha Ε.; Kedem, Alon; Katorza, E.; Moran, Orit; Achiron, Reuven

doi:10.1002/uog.12304

Cited by 53 publications

(47 citation statements)

References 19 publications

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“…Recently the use of ultrasound has been suggested as an accurate and practical tool to measure the SPA width during pregnancy and prior to labor. Some authors have measured the SPA by 2D ultrasound in women with prolonged second stage and reported a higher risk of obstetric intervention in those with a narrower angle [1]. However, in that study the reproducibility of the SPA measurement by 2D ultrasound was not investigated, though this may represent a main limitation of the suggested technique.…”

Section: Introductionmentioning

confidence: 64%

Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women

et al. 2015

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Objective: To assess whether subpubic arch angle (SPA) measurement before labor onset can predict labor outcome among low-risk pregnant women. Methods: 3D ultrasound volume was transperineally acquired from a series of nulliparous women with uncomplicated pregnancy at term before the onset of labor. SPA was measured offline using Oblique View Extended Imaging (OVIX) on each volume performed by an investigator not involved in the clinical management. Labor outcome was prospectively investigated in the whole study group. Results: Overall, 145 women were enrolled in the study. Of these, 83 underwent spontaneous vaginal delivery, whereas obstetric intervention was performed in 62 cases (Cesarean section in 40 and vacuum extraction in 22). The SPA appeared to be significantly narrower in the women submitted to obstetric intervention compared with those undergoing spontaneous vaginal delivery (116.8 ± 10.3° vs. 123.7 ± 9.6°, p < 0.01). At multivariate analysis SPA and maternal age were identified as independent predictors of the mode of delivery. On the other hand, the duration of labor did not show a significant relationship with SPA. Conclusions: In low-risk nulliparous women at term gestation, SPA measurement obtained by 3D ultrasound before the onset of labor seems to predict the likelihood of an obstetric intervention but not the duration of labor.

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Section: Introductionmentioning

confidence: 64%

Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women

et al. 2015

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“…Of course, it would be interesting to assess if the width of the SPA may have a clinical impact on the labor outcome and more precisely to evaluate if a smaller SPA is associated with an increased risk of prolonged labor and dystocia, as previously suggested by clinical [14], radiological [5,15,16,17] and sonographic studies [6]. This will be the subject of a forthcoming study from our group with the aim of investigating if the maternal pubic ultrasound may be combined with the sonographic parameters of the fetal head descent to predict the chance of a spontaneous vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Very recently, the use of 2-D ultrasound has been proposed in the assessment of the subpubic arch angle in women with prolonged second stage of labor [6]. The authors have demonstrated that a smaller angle may predict the risk of caesarean section in this population.…”

Section: Introductionmentioning

confidence: 99%

A New Method to Measure the Subpubic Arch Angle Using 3-D Ultrasound

et al. 2015

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Objectives: The aim of this study was to assess the reproducibility of both a new contrast-enhancing technique (Oblique View eXtended Imaging, OVIX; Samsung) and the recently reported 3-D multiplanar technique (MPT) in the measurement of the subpubic angle (SPA) among a group of women at term gestation. In addition, we aimed to study the intermethod agreement between the OVIX technique and MPT. Methods: We acquired a transperineal 3-D ultrasound volume from 155 women with a singleton uncomplicated term pregnancy before the onset of labor. Each 3-D dataset was analyzed by the MPT and OVIX algorithm. The angle formed by the lower edges of the pubic rami (SPA) was measured twice by an operator and once by another operator for each technique in order to assess intra- and interobserver reproducibility. Reproducibility and intermethod agreement were studied by means of the intraclass correlation coefficient (ICC) and Bland-Altman method. Results: SPA measurements performed with OVIX showed high intraobserver [ICC 0.912, 95% confidence interval (CI) 0.882-0.935] and good interobserver (ICC 0.791, 95% CI 0.724-0.844) agreement, while those measured with MPT showed moderate intraobserver (ICC 0.573, 95% CI 0.457-0.670) and good interobserver (ICC 0.640, 95% CI 0.537-0.724) agreement. Whereas the intermethod analysis showed good agreement between the MPT and the OVIX techniques (ICC 0.614, 95% CI 0.414-0.757), the SPA measured by MPT were significantly wider than those measured by OVIX (125 ± 12 vs. 120 ± 11°, p = 0.006). Conclusions: OVIX is a reliable technique for SPA measurement. MPT overestimates the SPA in comparison with OVIX. Further studies are needed to assess its clinical utility.

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“…Recently, however, two studies have used ultrasound as a means of image acquisition for obstetric pelvimetry: the first was performed by the gynecologist [5] at the Chaim Sheba Medical Center in collaboration with the university's medical school of Tel Aviv in Israle, the other from the gynecologist [6] and other experts, at the Prince of Wales Hospital in collaboration with the Honk Hong University.…”

Section: David Publishingmentioning

confidence: 99%

The Pubic Arch Angle: A Study on the Predictability of Labor and Delivery

Pioli¹,

Gatti²,

Marcelli³

et al. 2018

JHS

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Study objective: to verify if the PAA (angle of the pubic arch) is a predictive data for the mode of delivery, the duration of labour and the expulsion period. Methods: we chose to measure the PAA in 100 women recruited, chosen from the 38th to the 42th week of gestation. The method involves the use of two-dimensional transperineal ultrasound. Data collection took place over a period of time from May to September 2015. The ante-partum data taken into consideration were the patient's name and surname, PAA, parity, age, height; those acquired in the post-partum provide for the calculation in minutes of the active phase of labor, the duration of the expulsion period, the execution of the amniorrhexis and the use of the synthetic oxytocin, the fetal cranial circumference, the fetal weight and the position of the presented part. Results: results discovered ultrasoundly 100 PAA, with an average value of 115.5° and we proceeded by evaluating 90 vaginal births. Infants at birth had a CC with an average value of 34.5 mm. By relating the two variables PAA and CC for the dependent variable "period expulsion in minutes", confirming that the expulsive period depends on the relationship between PAA and CC. The average of the minutes of the expulsion period is 50' in women with a PAA > 111.5° and a CC > 34.5 mm while in women with an PAA > 111.5° the media time is 30' regardless of the CC. It has been shown that oxytocin and amniorrhexis reduce the minutes of the expulsion period only in a case of PAA > 111.5° and a CC > 34.5 mm bringing them from 60' to 23'. Conclusion: the duration of the active phase of labor is not influenced by the PAA but it depends on external factors. In the case of the expulsion period, a predictability of the PAA on its duration is shown if the CC is taken into consideration; as regards the influence of the PAA on the method of delivery, it was not possible to carry out any analysis since all the useful cases had vaginal delivery.

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Pubic arch angle in prolonged second stage of labor: clinical significance

Abstract: ABSTRACT

Cited by 53 publications

References 19 publications

Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women

Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women

A New Method to Measure the Subpubic Arch Angle Using 3-D Ultrasound

The Pubic Arch Angle: A Study on the Predictability of Labor and Delivery

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