The role of the angle of progression in the prediction of the outcome of occiput posterior position in the second stage of labor

Brunelli, Elena; Youssef, A.; Soliman, Ehab; Prete, Biancamaria Del; Mahmoud, M. R.; Fikry, Mohamed; Pilu, G.; Kamel, Rasha

doi:10.1016/j.ajog.2021.01.017

Cited by 11 publications

(4 citation statements)

References 56 publications

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“…In this study, we could not replicate these results, as we did not find a significant difference in the fetal spine position between our groups (Table 1). More recently, Brunelli et al 15 investigated the relationship between the fetal head station and persistent OP, showing a relationship between a narrow AoP at the beginning of the second stage of labor and a higher incidence of persistent OP position. However, in their study, the authors did not evaluate the degree of flexion of the fetal head.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there is no clear explanation as to why some fetuses rotate spontaneously and others persist in an OP position. Several risk factors for persistent OP position, including maternal and neonatal characteristics 3,14 and intrapartum sonographic parameters, have been described 15,16 . Recently, a retrospective study conducted on OP fetuses reported an association between clinically assessed head attitude and spontaneous rotation into an OA position at birth 17 .…”

Section: Introductionmentioning

confidence: 99%

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Prediction of persistent occiput posterior position by sonographic assessment of fetal head attitude at start of second stage of labor: prospective study

Ramirez Zegarra,

Dall'Asta,

Di Pasquo

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesTo evaluate the relationship between the flexion of the fetal head quantified by means of the chin‐to‐chest angle (CCA) in fetuses in OP position at the beginning of the second stage of labor, and persistent OP position at birth.MethodsSingle‐center, prospective, observational study conducted at the University Hospital of Parma, Italy. We included singleton pregnancies at term with fetuses in OP position at the beginning of the second stage of labor. The fetal head position, station by means of angle of progression and head‐to‐perineum distance; and attitude by means of CCA were assessed using transabdominal or transperineal ultrasound. The primary outcome of the study was the occurrence of persistent OP position at birth, including spontaneous or operative (abdominal or vaginal) delivery.ResultsBetween January 2022 and July 2022, 76 women were included in the study. There were 48 (63.2%) spontaneous rotations of the fetal head, and in all spontaneous vaginal delivery occurred. Among the 28 (36.8%) fetuses that did not rotate spontaneously into an OA position, eight (28.6%) had a spontaneous vaginal delivery while assisted vaginal birth and cesarean delivery were performed in 11 (39.3%) and 9 (32.1%) cases respectively. Multivariable logistic regression analysis showed that the CCA (aOR 2.15, 95% CI 1.22 – 3.78; P=0.008) and nulliparity (aOR 0.20, 95% CI 0.06 – 0.76; P=0.02) were independently associated with persistent OP position at birth. Moreover, the CCA showed an AUC of 0.69 (95% CI 0.56 – 0.82, p=0.005) for the prediction of persistent OP position. The optimal cut‐off value of the CCA was 36.5 degrees, and was associated with 0.82 (95% CI 0.63 – 0.94) sensitivity, 0.50 (95% CI 0.35 – 0.65) specificity, 0.49 (95% CI 0.34 – 0.64) positive predictive value, 0.83 (95% CI 0.64 – 0.94) negative predictive value, 1.64 (95% CI 1.18 – 2.29) positive likelihood ratio, and 0.36 (95% CI 0.15 – 0.83) negative likelihood ratio.ConclusionsOur data shows that within a population of women with fetal OP position at the beginning of the second stage of labor the sonographic fetal attitude measured by means of the CCA might help in the identification of fetuses at risk of persistent OP position. Such findings can be useful for patient counselling when OP position is diagnosed at full cervical dilatation. Further studies should investigate if the CCA might select patients who may benefit from manual rotation of the fetal head.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prediction of persistent occiput posterior position by sonographic assessment of fetal head attitude at start of second stage of labor: prospective study

Ramirez Zegarra,

Dall'Asta,

Di Pasquo

et al. 2024

Ultrasound in Obstet & Gyne

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“…B. des Angle of progression (AoP) zur Bestimmung des Höhenstandes sind aktuell von Experten beschrieben. Diese Distanzen sind bei der dorsoposterioren Lage jedoch etwas schwieriger anzuwenden, es gibt dafür bisher weniger wissenschaftliche Evidenz 2 7 8 .…”

Section: Diagnose Der Einstellungs- Und Haltungsanomalieunclassified

Die dorsoposteriore Lage und geburtshilfliche Interventionen

Reitter¹

2022

Hebamme

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Durch die Ausrichtung des kindlichen Rückens und des kindlichen Kopfes kommt es bei der dorsoposterioren Lage zu einer ungünstigen Führungslinie. Handgriffe wie die digitale oder manuelle Rotation bieten eine Chance, die Lage zu korrigieren. Gelingt das Manöver, lassen sich möglicherweise eine vaginal-operative Geburt oder ein Kaiserschnitt vermeiden.

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“…The AoP first described in 2009 (Barbera et al, 2009;Kalache et al, 2009) is defined as the angle between the long axis of the pubic symphysis (PS) and a line from the lower endpoint of PS drawn tangential to the FH contour (Ghi et al, 2009;Dückelmann et al, 2010;Youssef et al, 2013). Several studies have suggested that AoP is an objective, accurate, reliable and reproducible parameter for the assessment of FH descent to provide the best diagnosis that will support the clinician in his/her daily decision (Montaguti et al, 2018;Dall'asta et al, 2019;Brunelli et al, 2021;Youssef et al, 2021). Frontiers in Physiology frontiersin.org…”

Section: Introductionmentioning

confidence: 99%

A framework for computing angle of progression from transperineal ultrasound images for evaluating fetal head descent using a novel double branch network

Bai

Sun²,

Yu³

et al. 2022

Front. Physiol.

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Background: Accurate assessment of fetal descent by monitoring the fetal head (FH) station remains a clinical challenge in guiding obstetric management. Angle of progression (AoP) has been suggested to be a reliable and reproducible parameter for the assessment of FH descent.Methods: A novel framework, including image segmentation, target fitting and AoP calculation, is proposed for evaluating fetal descent. For image segmentation, this study presents a novel double branch segmentation network (DBSN), which consists of two parts: an encoding part receives image input, and a decoding part composed of deformable convolutional blocks and ordinary convolutional blocks. The decoding part includes the lower and upper branches, and the feature map of the lower branch is used as the input of the upper branch to assist the upper branch in decoding after being constrained by the attention gate (AG). Given an original transperineal ultrasound (TPU) image, areas of the pubic symphysis (PS) and FH are firstly segmented using the proposed DBSN, the ellipse contours of segmented regions are secondly fitted with the least square method, and three endpoints are finally determined for calculating AoP.Results: Our private dataset with 313 transperineal ultrasound (TPU) images was used for model evaluation with 5-fold cross-validation. The proposed method achieves the highest Dice coefficient (93.4%), the smallest Average Surface Distance (6.268 pixels) and the lowest AoP difference (5.993°) by comparing four state-of-the-art methods. Similar results (Dice coefficient: 91.7%, Average Surface Distance: 7.729 pixels: AoP difference: 5.110°) were obtained on a public dataset with >3,700 TPU images for evaluating its generalization performance.Conclusion: The proposed framework may be used for the automatic measurement of AoP with high accuracy and generalization performance. However, its clinical availability needs to be further evaluated.

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The role of the angle of progression in the prediction of the outcome of occiput posterior position in the second stage of labor

Cited by 11 publications

References 56 publications

Prediction of persistent occiput posterior position by sonographic assessment of fetal head attitude at start of second stage of labor: prospective study

Prediction of persistent occiput posterior position by sonographic assessment of fetal head attitude at start of second stage of labor: prospective study

Die dorsoposteriore Lage und geburtshilfliche Interventionen

A framework for computing angle of progression from transperineal ultrasound images for evaluating fetal head descent using a novel double branch network

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