Open AccessFetal head–symphysis distance and mode of delivery in the second stage of labor
Author(s) -
Youssef Aly,
Maroni Elisa,
Cariello Luisa,
Bellussi Federica,
Montaguti Elisa,
Salsi Ginevra,
MorselliLabate Antonio Maria,
Paccapelo Alexandro,
Rizzo Nicola,
Pilu Gianluigi,
Ghi Tullio
Publication year - 2014
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12454
Subject(s) - medicine , symphysis , fetal head , vaginal delivery , logistic regression , pubic symphysis , stage (stratigraphy) , obstetrics , ultrasound , surgery , pregnancy , fetus , radiology , paleontology , biology , pelvis , genetics
Objective To evaluate whether the fetal head–symphysis distance measured by three‐dimensional transperineal ultrasound during the active second stage predicts operative delivery. Design Prospective observational study. Setting University hospital, Bologna, Italy. Population Seventy‐one nulliparous women at term in active second stage of labor. Methods We acquired a series of sonographic volumes at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5, T6) until delivery. All volumes were retrospectively analyzed and head–symphysis distance was measured for each acquisition. We compared head–symphysis distance between women with spontaneous vaginal delivery and those with operative delivery. Receiver operator characteristic curves were constructed to estimate the accuracy of head–symphysis distance in the prediction of operative delivery. Logistic regression was used to identify independent variables associated with operative delivery. Main outcome measures Operative delivery (vacuum or cesarean). Results Of the women included, 81.7% had a spontaneous vaginal delivery and 18.3% underwent operative delivery. Women with spontaneous vaginal delivery had shorter head–symphysis distance than women in the operative delivery group at T1 ( p < 0.001), T2 ( p < 0.001) and T3 ( p = 0.025), whereas no significant differences were recorded thereafter. Receiver operator characteristic curves revealed accuracy values of 81.0%, 87.9% and 77.6% in the prediction of operative delivery at T1, T2 and T3, respectively. At multivariate logistic regression head–symphysis distance and epidural analgesia were the only independent predictors of operative delivery among ultrasonographic, maternal and intrapartum variables. Conclusions Ultrasonographic measurement of head–symphysis distance in the second stage of labor can be used to predict operative delivery.