What is the most reliable ultrasound parameter for assessment of fetal head descent?

Molina, Francisca S.; Terra, Ricardo Mingarini; Carrillo, María Paz; Puertas, Alberto; Nicolaides, Kypros H.

doi:10.1002/uog.7709

Cited by 128 publications

(113 citation statements)

References 15 publications

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“…Molina et al [7], among other authors [13,14], evaluated the reproducibility of the different ultrasound parameters used to assess the evolution of delivery and concluded that the angle of descent is the most reproducible parameter for measuring fetal head progression during labor, whereas Duckelmann et al [10], showed that the determination of this ultrasound parameter is also independent of the professional's experience.…”

Section: Spontaneous Vaginal Delivery Occurred In 72 (71%) Women Insmentioning

confidence: 99%

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Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

Pérez¹,

Seguer²,

Pujadas³

et al. 2017

Clin Obstet Gynecol Reprod Med

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Objective: The aim of this study was to investigate the role of the 'angle of progression' (AOP) in the prediction of vaginal delivery and establish a cut-off value.Method: 101 pregnant women were included in this prospective study. They were admitted in labor to our hospital and had singleton cephalic presentations and full-term pregnancies. AOP was measured at admission time. We analyzed the results of all the women included but also a subgroup of 66 singleton pregnant women whose assessment of the AOP was performed at the beginning of the second stage of labor.Results: Ninety-one patients had a vaginal delivery (90%) and 19 a cesarean section (10%).The area under the curve was 0.85 (95% confidence interval [CI], 0.77-0.92)and the value of the AOP that optimizes the curve was 125º (S 67.1% E 100%). In the subgroup that was assessed at the second stage of labor, the area under the curve was 0.97 (95%CI,0.90-0.99) and a value of the AOP that optimizes the curve was also 125º (S 91.38% E 100%). Conclusions:The angle of progression is a simple and reliable intrapartum ultrasound parameter for the evaluation of fetal head descent. Transperineal ultrasound assessment could help to decide the method of delivery. In our experience, the sensitivity of the ultrasound measurement increases when this is taken in the second stage of childbirth.

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Section: Spontaneous Vaginal Delivery Occurred In 72 (71%) Women Insmentioning

confidence: 99%

“…Recent studies show that ultrasonographical assessment of fetal head descent through use of intrapartum ultrasound can help to solve these limitations [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

Pérez¹,

Seguer²,

Pujadas³

et al. 2017

Clin Obstet Gynecol Reprod Med

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“…The value of this conversion was recently appreciated in another article in UOG 4 . The angle of descent is also easy to obtain and is reproducible 3,5 . We suggest using the parameter 'head direction' -in addition to head station -as we initially described it, because it enables a simple assessment 'at a glance'.…”

Section: Quantification Of Fetal Head Direction and Descentmentioning

confidence: 99%

Quantification of fetal head direction and descent

Tutschek

Braun

Chantraine³

et al. 2012

Ultrasound in Obstet & Gyne

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“…Alone or in combination with other ultrasound parameters, HD has proved useful in the prediction of vaginal and successful operative delivery 4,10 . The abovementioned linear and angle assessments can be obtained in a semiautomatic manner, using threedimensional ultrasound 11 , but this is not widely available for use on the labor ward, requires additional skills to perform and has not been shown to provide further benefit over two-dimensional ultrasound 12 . Most of these linear distances and angles can be determined quickly and simply by measuring a single angle (progression angle, middle-line angle), a single distance (head-to-perineum distance) or a combination of a 90…”

mentioning

confidence: 99%

“…HD. Finally, this parameter is quantified by measuring the direction angle (DA) between the IL and the HD 11,14 . In some studies 4,10 , HD is classified in this final step in relation to the SPla: 'head up' (when it points ventrally at an angle of > 30…”

mentioning

confidence: 99%

Quantification of fetal head direction using transperineal ultrasound: an easier approach

Iliescu

Adam

Tudorache

et al. 2012

Ultrasound in Obstet & Gyne

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Quantification of fetal head direction using transperineal ultrasound: an easier approachUltrasound offers several advantages for planning and monitoring labor, being a safe, non-invasive and easyto-learn technique, which offers accurate and objective information, even in difficult clinical situations. Several linear measurements (progression distance and head-toperineum distance) and angles (head direction (HD), progression angle and middle-line angle), have been shown to be useful in the estimation of fetal head progression 1 -10 . The rationale for assessing HD during the second stage of labor is the curvilinear path of fetal head descent, directed initially downward then horizontally and finally upward, that can be easily tracked in the sagittal transperineal view. Alone or in combination with other ultrasound parameters, HD has proved useful in the prediction of vaginal and successful operative delivery 4,10 . The abovementioned linear and angle assessments can be obtained in a semiautomatic manner, using threedimensional ultrasound 11 , but this is not widely available for use on the labor ward, requires additional skills to perform and has not been shown to provide further benefit over two-dimensional ultrasound 12 . Most of these linear distances and angles can be determined quickly and simply by measuring a single angle (progression angle, middle-line angle), a single distance (head-to-perineum distance) or a combination of a 90• angle and a line (progression distance). However, a recent systematic review 13 does not wholly support the use of ultrasound in labor and there is an argument that some measures are too complicated. For example, for quantification of HD, first the maternal reference parameter, the infrapubic line (IL), is drawn perpendicular to the symphysis pubis long axis (SPla), starting from the inferior symphyseal margin. Then the fetal parameter, the widest head diameter, is traced. Fetal head descent with respect to the pubic symphysis and IL is evaluated by drawing a line perpendicular to the widest diameter of the fetal head, i.e. HD. Finally, this parameter is quantified by measuring the direction angle (DA) between the IL and the HD 11,14 . In some studies 4,10 , HD is classified in this final step in relation to the SPla: 'head up' (when it points ventrally at an angle of > 30• ), 'head down' (when this angle is < 0 • ) and 'horizontal' (when this angle is 0-30• ). We propose an easier assessment of DA, by reducing the number of steps in the protocol. In Figure 1 we show how the classical measurement is equivalent to the angle between the fetal biparietal diameter and SPla. Thus, the steps described above can be substituted by the measurement of one angle between two lines similar, for example, to measurement of the fetal cardiac axis (Figure 2). Increasing values of this angle signify Figure 1 Classical fetal head direction angle (angle DA1), between infrapubic line (IL) and head direction (HD), is equal to angle between biparietal diameter (BPD) and symphysis pubis long axis (SP...

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What is the most reliable ultrasound parameter for assessment of fetal head descent?

Abstract: Objectives

Cited by 128 publications

References 15 publications

Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

Quantification of fetal head direction and descent

Quantification of fetal head direction using transperineal ultrasound: an easier approach

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