Prediction of the Mode of Delivery using Intrapartum Translabial Ultrasound in a Teaching Hospital in South India – A prospective observational study

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Vinutha MB
Vinutha Vinod
Chitra Kotian
Krupa Shah
Shashikala K Bhat

Abstract

Objectives: Cervical effacement and dilatation, station of the presenting part, and fetal head position are the key determinants of progress of labor. There is growing evidence about the usefulness of intrapartum ultrasound in evaluating the labor parameters objectively to decide about the labor management. Hence, intrapartum translabial ultrasound was studied to predict the mode of delivery.
Materials and Methods: 185 laboring women with singleton pregnancy, term gestation, and cephalic presentation with 4 cm. cervical dilatation were included. Intrapartum translabial ultrasound was done to note angle of progression (AoP), cervical length, and position of the fetal head.
Results: Among 185 women, 121 (65.4%) had vaginal (112 normal and 9 assisted vaginal) and 64 cesarean (34.6%) delivery. An angle of progression of 89o with area under the curve (AUC) 0.789 (p ≤ 0.0001) measured in the early active phase of labor had a sensitivity, specificity, positive predictive value and negative predictive value of 79.3% and 65.6%, 81.3% and 62.7% respectively. The positive likelihood ratio and the negative likelihood ratio were 2.3 and 0.315, respectively. The clinical utility index for AoP was 0.644 in predicting the mode of delivery. AUC for cervical length was 0.534 (p = 0.452), which was not significant. The odds ratio for occipitoanterior position in predicting vaginal delivery was 3.9.
Conclusion: Intrapartum translabial ultrasound is a reproducible and feasible method to evaluate labor parameters. Assessing multiple components like the angle of progression, cervical length, and position of the fetal head in early labor could help to predict the mode of delivery.

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References

Siergiej M, Sudoł-Szopińska I, Zwoliński J, Śladowska-Zwolińska AM. Role of intrapartum ultrasound in modern obstetrics – current perspectives and literature review. J Ultrason 2019;19:295-301.

Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol 2018;52:128-39.

Dietz HP, Lanzarone V. Measuring engagement of the fetal head: validity and reproducibility of a new ultrasound technique. Ultrasound Obstet Gynecol 2005;25:165-8.

Barbera AF, Pombar X, Perugino G, Lezotte DC, Hobbins JC. A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol 2009;33:313-9.

Adam G, Sirbu O, Voicu C, Dominic D, Tudorache S, Cernea N. Intrapartum ultrasound assessment of fetal head position, tip the scale: natural or instrumental delivery? Curr Health Sci J 2014;40:18-22.

Malvasi A, Tinelli A, Barbera A, Eggebø TM, Mynbaev OA, Bochicchio M, et al. Occiput posterior position diagnosis: vaginal examination or intrapartum sonography? A clinical review. J Matern Neonatal Med 2014;27:520-6.

Dückelmann AM, Bamberg C, Michaelis SAM, Lange J, Nonnenmacher A, Dudenhausen JW, et al. Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet Gynecol 2010;35:216-22.

Pina Pérez S, Jurado Seguer J, Pujadas AR, Serra Azuara L, Lleberia Juanos J, Aguiló Sagristà O. Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode. Clin Obstet Gynecol Reprod Med 2017;3:1-4.

Tutschek B, Braun T, Chantraine F, Henrich W. A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent. BJOG 2011;118:62-9.

Wiafe YA, Whitehead B, Venables H, Odoi AT. Sonographic parameters for diagnosing fetal head engagement during labour. Ultrasound 2018;26:16-21.

Kohls F, Brodowski L, Kuehnle E, Kniebusch N, Kalache KD, Weichert A. [Intrapartum Translabial Ultrasound: A Systematic Analysis of The Fetal Head Station in The First Stage of Labor]. Z Geburtshilfe Neonatol 2018;222:19-24.

Ionescu CA, Coroleucă C, Pleș L, Dimitriu M, Banacu M, Viezuină R, Bohiltea R. Ultrasound during labour. Gineco.eu 2016;12:211-3.

Henrich W, Dudenhausen J, Fuchs I, Kämena A, Tutschek B. Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction. Ultrasound Obstet Gynecol 2006;28:753-60.

Dückelmann AM, Bamberg C, Michaelis SAM, Lange J, Nonnenmacher A, Dudenhausen JW, et al. Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet Gynecol 2010;35:216-22.

Zilianti M, Azuaga A, Calderon F, Pagés G, Mendoza G. Monitoring the effacement of the uterine cervix by transperineal sonography: a new perspective. J Ultrasound Med 1995;14:719-24.

Sherer DM. Intrapartum ultrasound. Ultrasound Obstet Gynecol 2007;30:123-39.

Molina FS, Nicolaides KH. Ultrasound in labor and delivery. Fetal Diagn Ther 2010;27:61-7.

Ahn KH, Oh M-J. Intrapartum ultrasound: A useful method for evaluating labor progress and predicting operative vaginal delivery. Obstet Gynecol Sci 2014;57:427.

Kalache KD, Dückelmann AM, Michaelis SAM, Lange J, Cichon G, Dudenhausen JW. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the “angle of progression” predict the mode of delivery? Ultrasound Obstet Gynecol 2009;33:326-30.

Barbera AF, Imani F, Becker T, Lezotte DC, Hobbins JC. Anatomic relationship between the pubic symphysis and ischial spines and its clinical significance in the assessment of fetal head engagement and station during labor. Ultrasound Obstet Gynecol 2009;33:320-5.

Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN, et al. Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound. Ultrasound Obstet Gynecol 2011;37:712-6.

Usman S, Lees C. Benefits and pitfalls of the use of intrapartum ultrasound. Australas J Ultrasound Med 2015;18:53-9.

Levy R, Zaks S, Ben-Arie A, Perlman S, Hagay Z, Vaisbuch E. Can angle of progression in pregnant women before onset of labor predict mode of delivery? Ultrasound Obstet Gynecol 2012;40:332-7.

Gillor M, Vaisbuch E, Zaks S, Barak O, Hagay Z, Levy R. Transperineal sonographic assessment of angle of progression as a predictor of successful vaginal delivery following induction of labor. Ultrasound Obstet Gynecol 2017;49:240-5.

Minajagi PS, Srinivas SB, Hebbar S. Predicting the Mode of Delivery by Angle of Progression (AOP) before the Onset of Labor by Transperineal Ultrasound in Nulliparous Women. Curr Women’s Health Rev 2020;16:39-45.

Eggebø TM, Hassan WA, Salvesen KÅ, Lindtjørn E, Lees CC. Sonographic prediction of vaginal delivery in prolonged labor: a two-center study. Ultrasound Obstet Gynecol 2014;43:195-201.

Torkildsen EA, Salvesen KÅ, Eggebø TM. Prediction of delivery mode with transperineal ultrasound in women with prolonged first stage of labor. Ultrasound Obstet Gynecol 2011;37:702-8.

Tan PC, Vallikkannu N, Suguna S, Quek KF, Hassan J. Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery. Ultrasound Obstet Gynecol 2007;29:568-73.

Giyahi H, Marsosi V, Faghihzadeh S, Kalbasi M, Lamyian M. Sonographic measurement of cervical length and its relation to the onset of spontaneous labour and the mode of delivery. Natl Med J India 2018;31:70.

Alanwar A, Hussein SH, Allam HA, Hussein AM, Abdelazim IA, Abbas AM, et al. Transvaginal sonographic measurement of cervical length versus Bishop score in labor induction at term for prediction of caesarean delivery. J Matern Neonatal Med 2019;1-8.

Verhoeven CJM, Opmeer BC, Oei SG, Latour V, van der Post JAM, Mol BWJ. Transvaginal sonographic assessment of cervical length and wedging for predicting outcome of labor induction at term: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42:500-8.

Khazardoost S, Ghotbizadeh Vahdani F, Latifi S, Borna S, Tahani M, Rezaei MA, et al. Pre-induction translabial ultrasound measurements in predicting mode of delivery compared to bishop score: a cross-sectional study. BMC Pregnancy Childbirth 2016;16:330.

Aggarwal K, Yadav A. Role of transvaginal ultrasonographic cervical assessment in predicting the outcome of induction of labor. Int J Reprod Contraception Obstet Gynecol 2019;8:628.

Wiafe YA, Whitehead B, Venables H, Dassah ET. Comparing intrapartum ultrasound and clinical examination in the assessment of fetal head position in African women. J Ultrason 2019;19:249-54.

Eggebø TM, Hassan WA, Salvesen KÅ, Torkildsen EA, Østborg TB, Lees CC. Prediction of delivery mode by ultrasound-assessed fetal position in nulliparous women with prolonged first stage of labor. Ultrasound Obstet Gynecol 2015;46:606-10.

Choi SK, Park YG, Lee DH, Ko HS, Park IY, Shin JC. Sonographic assessment of fetal occiput position during labor for the prediction of labor dystocia and perinatal outcomes. J Matern Neonatal Med 2016;29:3988-92.

Akmal S, Kametas N, Tsoi E, Howard R, Nicolaides KH. Ultrasonographic occiput position in early labour in the prediction of caesarean section. BJOG 2004;111:532-6.

Verhoeven CJM, Rückert MEPF, Opmeer BC, Pajkrt E, Mol BWJ. Ultrasonographic fetal head position to predict mode of delivery: A systematic review and bivariate meta-analysis. Ultrasound Obstet Gynecol 2012;40:9-13.

Eggebø TM, Wilhelm-Benartzi C, Hassan WA, Usman S, Salvesen KA, Lees CC. A model to predict vaginal delivery in nulliparous women based on maternal characteristics and intrapartum ultrasound. Am J Obstet Gynecol 2015;213:362.e1-362.e6.