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Clinical Summary

Predicting the outcome of prolonged second stage of labor?

Takeaway

  • Ultrasound measurements may identify women with a good chance of spontaneous vaginal delivery (SVD) after a prolonged second stage of labor.

Why this matters

  • Identification of women likely to have SVD can help reduce unnecessary interventions and maternal and neonatal morbidity.

Key results

  • Compared with the operative delivery group, SVD was associated with:
    • Occiput anterior position (P<.0001),
    • Shorter head-perineum distance (P=.001),  
    • Narrower mean volume of the midline angle (P<.001),  
    • Shorter head-symphysis distance (P<.001), and 
    • Wider Delta-angle of progression at the acme of pushing (P=.02).
  • The midline angle (aOR, 1.075; P=.014) and the head-symphysis distance (aOR, 1.299; P=.024) were the only independent predictors of mode of delivery after logistic regression analysis.
  • Operative delivery was associated with higher blood loss and lower 5-minute Apgar scores compared with the SVD group.

Study design

  • Prospective, observational, 2-centre, cohort study.
  • Nulliparous women pushing >120 minutes were eligible for inclusion (n=109).
  • Ultrasound measurements: midline angle, head-perineum distance, head-symphysis distance between contractions, and angle of progression at rest and at peak of maternal pushing effort.
  • Primary outcome: comparison of measurements with SVD, operative delivery, and cesarean delivery.
  • Funding: None.

Limitations

  • Most obstetricians are not trained to evaluate these measurements.

References


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