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Prediction of time to delivery by transperineal ultrasound in second stage of labor
Author(s) -
Yonetani N.,
Yamamoto R.,
Murata M.,
Nakajima E.,
Taguchi T.,
Ishii K.,
Mitsuda N.
Publication year - 2017
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.15944
Subject(s) - medicine , fetal head , cephalic presentation , hazard ratio , stage (stratigraphy) , proportional hazards model , confidence interval , labor induction , obstetrics , pregnancy , gynecology , vaginal delivery , cervix , fetus , ultrasound , surgery , radiology , cancer , paleontology , genetics , oxytocin , biology
Objective To investigate whether the transperineal sonographic ( TPS ) parameters angle of progression ( AoP ) and midline angle ( MLA ) can predict the time remaining in the second stage of labor. Methods We evaluated prospectively women with a singleton pregnancy in cephalic presentation at term between October 2013 and September 2014. TPS volumes were obtained immediately after confirmation by digital vaginal examination of a fully dilated cervix. AoP and MLA were measured offline by analyzing the ultrasound volumes. Progression of labor was evaluated every hour during the second stage. The associations of AoP and MLA with the interval between TPS assessment and delivery were evaluated using multivariable Cox proportional hazards analyses in nulliparous and parous women separately. Results A total of 557 women were evaluated. An AoP ≥ 160° (adjusted hazard ratio ( aHR ), 2.52 (95% CI , 1.98–3.19)) and MLA ≤ 10° ( aHR , 1.79 (95% CI , 1.35–2.34)) in nulliparous women and an AoP ≥ 150° ( aHR , 1.86 (95% CI , 1.34–2.57)) and MLA ≤ 20° ( aHR , 1.69 (95% CI , 1.21–2.34)) in parous women were significantly associated with the remaining time in labor. The positive/negative likelihood ratios of AoP , MLA , clinical station (fetal head descent as observed by digital examination) and clinical rotation (fetal head rotation as observed by digital examination) at these cut‐off points were 3.6/0.6, 2.0/0.6, 1.6/0.6 and 1.6/0.8, respectively, in nulliparous women, and 2.4/0.6, 1.3/0.7, 7.6/0.5 and 5.2/0.7, respectively, in parous women. Conclusion TPS assessment of AoP and MLA in the second stage of labor was useful for predicting the time remaining in labor and had higher predictive value than did digital vaginal examination in nulliparous women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.