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
References