Reliability of transperineal ultrasound for the assessment of the angle of progression in labor using parasagittal approach versus midsagittal approach

Kamel, Rasha; Negm, Sherif; Montaguti, Elisa; Dodaro, Maria Gaia; Brunelli, Elena; Donna, G. Di; Soliman, Ehab; Sharaf, M.; El-Harty, Ahmed

doi:10.1080/14767058.2019.1678143

Cited by 11 publications

(6 citation statements)

References 22 publications

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“…A number of studies have demonstrated previously that, even when the fetal head is easily palpable, the reproducibility of digital examination of fetal head engagement is poor [41][42][43][44] . TPU provides a highly reproducible and accurate tool for fetal head descent assessment, and it has high acceptability among women due to its non-invasiveness 22,25,26,[44][45][46][47][48][49][50] . We believe that accurate assessment of fetal breech descent in the birth canal by means of BPA measurement could help in providing more accurate and applicable predictive models of ECV success, although studies are needed to confirm this.…”

Section: Discussionmentioning

confidence: 99%

Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal

Youssef

Brunelli

Fiorentini

et al. 2021

Ultrasound in Obstet & Gyne

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Objective To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). Methods Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra‐ and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra‐ and interobserver agreement was also analyzed using Bland–Altman analysis. Student's t‐test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. Results Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra‐ and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80–0.93) and 0.83 (95% CI, 0.71–0.90), respectively. The mean difference between measurements was 0.4° (95% CI, −1.4 to 2.2°) for intraobserver repeatability and −0.4° (95% CI, −2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9–15.1°) and 13.6° (95% CI, 9.9–17.3°) for intra‐ and interobserver repeatability, respectively. The lower limits of agreement were −11.2° (95% CI, −14.3 to −8.1°) and −14.4° (95% CI, −18.2 to −10.7°) for intra‐ and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra‐ or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra‐ or interobserver reliability. Conclusions BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 99%

Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal

Youssef

Brunelli

Fiorentini

et al. 2021

Ultrasound in Obstet & Gyne

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“…61,65,66 Angle of progression (Figure 5) is the angle between the sagittal midline of the symphysis pubis and line dropping from the lowermost point of the symphysis pubis tangentially to the deepest point of the fetal head, on transperineal ultrasound. 67 The automated assessment of AoP, now available in some ultrasound systems, measures the AoP in a parasagittal plane and was demonstrated to be feasible, correlate well with assessment of fetal station by vaginal examination 68 and in excellent agreement with the originally described midsagittal AoP 69 .…”

Section: Assessment Of Fetal Head Position and Stationmentioning

confidence: 61%

The usefulness of ultrasound before induction of labor

Kamel

Garcia

Poon

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Many studies had been conducted to assess the correlation between AOP and successful vaginal delivery, and their results were very near to Barbera et al [12,13].…”

Section: Introductionmentioning

confidence: 84%

Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

Abdelhalim¹,

Abolmakarem²,

Hassan³

2021

World J. Adv. Res. Rev.

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Background: Failure of descent due to fetal malposition is one of the most common indications for performing surgical deliveries. It has recently been suggested that trans-perineal intra-partum ultrasonography may be useful in assessing fetal head engagement, position and station as well as it’s reliable, cheap, painless and effective tool. Measuring the ‘angle of progression’ could assist in the obstetrician’s decision regarding mode of delivery. Objectives: The primary outcome is to use the AOP to develop a predictive model for the probability of successful vaginal delivery. Secondary outcomes including assessment of possibly successful VBAC in previous one CS women. Methods: We recruited 500 women in labor. For each woman, a (TPU) was performed to measure the AOP in late first and second stages of labor. We compared AOP between women who delivered fetuses through vaginal route to those who delivered by CS. Results: Through 467 women included in the study, AOP was significantly Higher in spontaneous vaginal delivery group (with cut off 123°±8.5°) as compared with women delivered by vacuum or by CS (113°±10.5°) (P=0.003). The VBAC as another secodary outcome seems to be insignificant. Conclusions: TPU is safe, non-invasive and easily preformed technique which is useful to predict labor outcomes.

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Reliability of transperineal ultrasound for the assessment of the angle of progression in labor using parasagittal approach versus midsagittal approach

Cited by 11 publications

References 22 publications

Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal

Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal

The usefulness of ultrasound before induction of labor

Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

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