Open AccessIntrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women
Author(s) -
Sainz José A.,
GarcíaMejido José A.,
Aquise Adriana,
Bonomi María J.,
Borrero Carlota,
De La Fuente Paloma,
FernándezPalacín Ana
Publication year - 2017
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.13230
Subject(s) - medicine , forceps , episiotomy , ultrasound , obstetrics , prospective cohort study , pregnancy , surgery , gynecology , radiology , genetics , biology
The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative (vacuum or forceps) deliveries in nulliparous women. Material and methods Prospective observational study of nulliparous women with an indication for operative delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a third‐/fourth‐degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion. Results A total of 143 nulliparous women were included in the study (82 vacuum‐assisted deliveries and 61 forceps‐assisted deliveries), with 20 fetuses in occiput posterior position. Forty‐seven operative deliveries were classified as complicated deliveries (28 vacuum‐assisted deliveries, 19 forceps‐assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birthweight (3229 ± 482 uncomplicated deliveries vs. 3623 ± 406 complicated deliveries; p < 0.003) and number of vacuum tractions (1.4 uncomplicated deliveries, 4.5 complicated deliveries; p < 0.0005). The strongest predictors of a complicated delivery, using the area under the receiver‐operating characteristics curve ( AUC ), were the angle of progression with active pushing (AoP2) ( AUC 86.9%) and the progression distance with active pushing ( PD 2) ( AUC 74.5%). The optimal cut‐off value for predicting a difficult operative delivery was an AoP2 of 153.5° (sensitivity 95.2%; false‐positive rate 5.9%) or PD 2 of 58.5 mm (sensitivity 95.2%; false‐positive rate 7.1%). Conclusions The sonographic parameters AoP2 and PD 2 can be used to predict cases of complicated operative deliveries in nulliparous women.