Relationship between intrapartum transperineal ultrasound measurement of angle of progression and head–perineum distance with correlation to conventional clinical parameters of labor progress and time to delivery

Chan, Ying Tze Viola; Ng, Vivian Kwun Sin; Yung, Wai Kuen; Lo, Tsz Kin; Leung, Wing Cheong; Lau, Wai Lam

doi:10.3109/14767058.2014.958459

Cited by 32 publications

(39 citation statements)

References 24 publications

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“…at the level of the ischial spines), whereas an AoP of 149.4 ± 16.2° corresponded to clinical fetal head station +2 (i.e. at 2 cm below the level of the ischial spines) . In the current study, the median AoP for instrumental delivery group at rest was 153.0°, which also corresponded to clinical fetal head station +2 (the definition of low operative vaginal delivery).…”

Section: Discussionsupporting

confidence: 51%

Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor

Chan

Lau

et al. 2018

Intl J Gynecology & Obste

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Objective To compare the angle of progression (AoP) measured by transperineal ultrasonography before indicating an instrumental delivery or cesarean delivery. Methods A prospective observational study was conducted among women with singleton term pregnancies with prolonged second stage of labor at Kwong Wah Hospital, Hong Kong, China, between May 16, 2011, and May 25, 2016. Transabdominal and transperineal ultrasonography were performed to determine fetal head position and AoP, respectively, both at rest and during uterine contraction with pushing. Mode of delivery was decided after vaginal examination without relying on ultrasonography. Results Of 143 women, 116 underwent successful instrumental delivery and 27 underwent cesarean delivery. Median AoP was 153.0° in the instrumental group versus 139.0° in the cesarean group at rest (P<0.001), and 182.5° in the instrumental group versus 156.5° in the cesarean group during contraction (P<0.001). The best predictive cutoff AoP for successful instrumental delivery was 138.7° at rest (sensitivity 86.2%, specificity 51.9%) and 160.9° during contraction (sensitivity 87.1%, specificity 74.1%). No between‐group differences in AoP were found for ease of vacuum extraction at rest (P=0.457) or during contraction with pushing (P=0.095). Conclusion The AoP predicted approximately 80% of successful instrumental deliveries performed for prolonged second stage of labor.

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Section: Discussionsupporting

confidence: 51%

Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor

Chan

Lau

et al. 2018

Intl J Gynecology & Obste

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“…Since Friedman's seminal work in the 1950s, vaginal examination has formed the basis for assessing progress in labor, with cervical dilatation, fetal head position and fetal head descent (station) all recorded at each assessment and plotted serially on a graph over time (partogram) [1][2][3][4] . However, vaginal examination is subjective, imprecise, uncomfortable for women and associated with infection, leading to calls for research into new approaches for assessing progress in labor [5][6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

“…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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“…Since 2006, ultrasound examination has supplemented vaginal examination for labour examination on a case-by-case basis in our unit [22][23][24][25][26] . We studied 125 women from 2015 to 2017 to determine whether prelabour ultrasound examination could predict the time to delivery from the appearance of show or irregular contractions, using transabdominal scan for head position and transperineal scan for cervical length and head perineal distance [27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

Opinions of midwives and pregnant women on prelabour ultrasound examination

Lau

Tai

et al. 2019

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Objectives:To survey the opinions of midwives and pregnant women on prelabour ultrasound examination. Methods: Questionnaires on prelabour ultrasound examination were distributed to 40 midwives and 125 pregnant women in a regional hospital. Results: 34 (85%) midwives and 125 (100%) pregnant women responded. Most midwives agreed or strongly agreed that prelabour ultrasound examination is acceptable with respect to workload (73.5%), enables labour ward beds to be utilised more efficiently (61.8%), should be encouraged for women not in labour (55.8%), and improves patient care (70.6%), and that most midwives are willing to learn and perform pre-labour ultrasound examination in future (85.3%). Subgroup analysis showed that the agree and non-agree groups did not differ significantly in terms of the number of prelabour ultrasound examination performed or years of labour ward experience. For pregnant women, 90.4% reported that it was their first ultrasound examination after admission for show or irregular contractions; 99.2% considered the study purpose clearly explained; 84.8% felt reassured that they were not yet in active labour after vaginal examination alone and 92.8% felt reassured with additional ultrasound examinations; 97.6% were satisfied with ultrasound examination and 95.2% would recommend it to others; and 72.8% reported no pain during ultrasound examination. Conclusion: Most midwives support prelabour ultrasound examination and are willing to learn the technique. Prelabour ultrasound examination is well-tolerated by pregnant women. It should be introduced to midwives and pregnant women to improve intrapartum care.

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Relationship between intrapartum transperineal ultrasound measurement of angle of progression and head–perineum distance with correlation to conventional clinical parameters of labor progress and time to delivery

Abstract: ITU parameters were moderately correlated with station. There was constant high correlation between AOP and HPD. Prediction of TD in primiparous women using ITU parameters was similar to that of using cervical dilatation.

Cited by 32 publications

References 24 publications

Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor

Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor

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

Opinions of midwives and pregnant women on prelabour ultrasound examination

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