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Sonographic risk assessment for an unplanned operative delivery: a prospective study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery.

Methods

In this prospective study, nulliparous women were recruited at 37.0–42.0 weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD.

Results

Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118.

Conclusion

Sonographic parameters representing maternal pelvic configuration (PAA) and maternal–fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.

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Data availability

Available upon request.

Code availability

Not applicable.

References

  1. Ferguson JE, Sistrom CL (2000) Can fetal-pelvic disproportion be predicted? Clin Obstet Gynecol 43:247–264

    Article  Google Scholar 

  2. Peleg D, Warsof S, Wolf MF, Perlitz Y, Shachar IB (2015) Counseling for fetal macrosomia: an estimated fetal weight of 4,000 g is excessively low. Am J Perinatol 32(1):71–74

    PubMed  Google Scholar 

  3. Elvander C, Högberg U, Ekéus C (2012) The influence of fetal head circumference on labor outcome: a population-based register study. Acta Obstet Gynecol Scand 91(4):470–475

    Article  Google Scholar 

  4. Mujugira A, Osoti A, Deya R, Hawes SE, Phipps AI (2013) Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study. BMC Pregnancy Childbirth 13:106

    Article  Google Scholar 

  5. Lipschuetz M, Cohen SM, Ein-Mor E, Sapir H, Hochner-Celnikier D, Porat S, Amsalem H, Valsky DV, Ezra Y, Elami-Suzin M, Paltiel O, Yagel S (2015) A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol 213(6):833.e1-833.e12

    Article  Google Scholar 

  6. Aviram A, Yogev Y, Bardin R, Hiersch L, Wiznitzer A, Hadar E (2016) Association between sonographic measurement of fetal head circumference and labor outcome. Int J Gynaecol Obstet 132(1):72–76

    Article  Google Scholar 

  7. Burke N, Burke G, Breathnach F, McAuliffe F, Morrison JJ, Turner M, Dornan S, Higgins JR, Cotter A, Geary M, McParland P, Daly S, Cody F, Dicker P, Tully E, Malone FD (2017) Perinatal Ireland research consortium. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter genesis study. Am J Obstet Gynecol 216(6):598.e1-598.e11

    Article  Google Scholar 

  8. Floberg J, Belfrage P, Ohlsen H (1987) Influence of pelvic outlet capacity on labor: a prospective pelvimetry study of 1429 unselected primiparas. Acta Obstet Gynecol Scand 66:127–130

    Article  CAS  Google Scholar 

  9. Korhonen U, Taipale P, Heinonen S (2014) The diagnostic accuracy of pelvic measurements: threshold values and fetal size. Arch Gynecol Obstet 290(4):643–648

    Article  CAS  Google Scholar 

  10. Korhonen U, Taipale P, Heinonen S (2015) Fetal pelvic index to predict cephalopelvic disproportion—a retrospective clinical cohort study. Acta Obstet Gynecol Scand 94(6):615–621

    Article  Google Scholar 

  11. Pattinson RC (2000) Pelvimetry for fetal cephalic presentations at term. Cochrane Database Syst Rev 2:CD000161

    Google Scholar 

  12. Sherer DM, Abulafia O (2003) Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations. Ultrasound Obstet Gynecol 21:430–436

    Article  CAS  Google Scholar 

  13. Dietz HP, Lanzarone V (2005) Measuring engagement of the fetal head: validity and reproducibility of a new ultrasound technique. Ultrasound Obstet Gynecol 25:165–168

    Article  CAS  Google Scholar 

  14. Eggebø TM, Heien C, Økland I, Gjessing LK, Romundstad P, Salvesen KÅ (2008) Ultrasound assessment of fetal head-perineum distance before induction of labor. Ultrasound Obstet Gynecol 32:199–204

    Article  Google Scholar 

  15. Barbera AF, Pombar X, Perugino G, Lezotte DC, Hobbins JC (2009) A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol 33:313–319

    Article  CAS  Google Scholar 

  16. Duckelmann AM, Bamberg C, Michaelis SA, Lange J, Nonnenmacher A, Dudenhausen JW, Kalache KD (2010) Measurement of fetal head descent using the “angle of progression” on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet Gynecol 35:216–222

    Article  CAS  Google Scholar 

  17. Molina FS, Terra R, Carrillo MP, Puertas A, Nicolaides KH (2010) What is the most reliable ultrasound parameter for assessment of fetal head descent? Ultrasound Obstet Gynecol 36:493–499

    Article  CAS  Google Scholar 

  18. Tutschek B, Braun T, Chantraine F, Henrich W (2011) A study of progress of labor using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent. BJOG 118:62–69

    Article  CAS  Google Scholar 

  19. Levy R, Zaks S, Ben-Arie A, Perlman S, Hagay Z, Vaisbuch E (2012) Can angle of progression in pregnant women before onset of labor predict mode of delivery? Ultrasound Obstet Gynecol 40(3):332–337

    Article  CAS  Google Scholar 

  20. Eggebø TM, Hassan WA, Salvesen KÅ, Lindtjørn E, Lees CC (2014) Sonographic prediction of vaginal delivery in prolonged labor: a two-center study. Ultrasound Obstet Gynecol 43(2):195–201

    Article  Google Scholar 

  21. Gillor M, Vaisbuch E, Zaks S, Barak O, Hagay Z, Levy R (2017) Transperineal sonographic assessment of the angle of progression as a predictor of a successful vaginal delivery following induction of labor. Ultrasound Obstet Gynecol 49(2):240–245

    Article  CAS  Google Scholar 

  22. Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN, Streitparth F, Teichgräber U, Henrich W, Dudenhausen JW, Kalache KD (2011) Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound. Ultrasound Obstet Gynecol 37:712–716

    Article  CAS  Google Scholar 

  23. Arthuis CJ, Perrotin F, Patat F, Brunereau L, Simon EG (2016) Computed tomographic study of anatomical relationship between symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound. Ultrasound Obstet Gynecol 48:779–785

    Article  CAS  Google Scholar 

  24. Liang CC, Chao M, Chang SD et al (2021) Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study. Arch Gynecol Obstet 304:599–608

    Article  Google Scholar 

  25. Perlman S, Kivilevitch Z, Moran O, Katorza E, Kees S, Achiron R, Gilboa Y (2017) Correlation between clinical fetal head station and sonographic angle of progression during the second stage of labor. J Matern Fetal Neonatal Med 4:1–6

    Google Scholar 

  26. Gilboa Y, Kivilevitch Z, Spira M, Kedem A, Katorza E, Moran O, Achiron R (2013) Pubic arch angle in prolonged second stage of labor: clinical significance. Ultrasound Obstet Gynecol 41(4):442–446

    Article  CAS  Google Scholar 

  27. Choi S, Chan SS, Sahota DS, Leung TY (2013) Measuring the angle of the subpubic arch using three-dimensional transperineal ultrasound scan: intraoperator repeatability and interoperator reproducibility. Am J Perinatol 30(3):191–196

    PubMed  Google Scholar 

  28. Ghi T, Youssef A, Martelli F, Montaguti E, Krsmanovic J, Pacella G, Pilu G, Rizzo N, Gabrielli S (2015) A new method to measure the subpubic arch angle using 3-D ultrasound. Fetal Diagn Ther 38(3):195–199

    Article  Google Scholar 

  29. Aldrich SB, Shek K, Krahn U, Dietz HP (2015) Measurement of subpubic arch angle by three-dimensional transperineal ultrasound and impact on vaginal delivery. Ultrasound Obstet Gynecol 46:496–500

    Article  Google Scholar 

  30. Youssef A, Ghi T, Martelli F, Montaguti E, Salsi G, Bellussi F, Pilu G, Rizzo N (2016) Subpubic arch angle and mode of delivery in low-risk nulliparous women. Fetal Diagn Ther 40(2):150–155

    Article  Google Scholar 

  31. Ghi T, Youssef A, Martelli F, Bellussi F, Aiello E, Pilu G, Rizzo N, Frusca T, Arduini D, Rizzo G (2016) Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery. Ultrasound Obstet Gynecol 48(4):511–515

    Article  CAS  Google Scholar 

  32. Ghi T, Dall’Asta A, Suprani A, Aiello E, Musarò A, Bosi C, Pedrazzi G, Kiener A, Arduini D, Frusca T, Rizzo G (2017) Correlation between subpubic arch angle and mode of delivery in large-for-gestational-age fetuses. Fetal Diagn Ther. https://doi.org/10.1159/000481169 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  33. Rizzo G, Aiello E, Bosi C, D’Antonio F, Arduini D (2017) Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand 96(8):1006–1011

    Article  Google Scholar 

  34. Perlman S, Raviv-Zilka L, Levinsky D, Gidron A, Achiron R, Gilboa Y, Kivilevitch Z (2018) The birth canal: correlation between the pubic arch angle, the interspinous diameter, and the obstetrical conjugate: a computed tomography biometric study in reproductive age women. J Matern Fetal Neonatal Med 22:1–11

    Google Scholar 

  35. Rozenholc AT, Ako SN, Leke RJ, Boulvain M (2007) The diagnostic accuracy of external pelvimetry and maternal height to predict dystocia in nulliparous women: a study in Cameroon. BJOG 114(5):630–635

    Article  CAS  Google Scholar 

  36. Liselele HB, Tshibangu CK, Meuris S (2000) Association between external pelvimetry and vertex delivery complications in African women. Acta Obstet Gynecol Scand 79(8):673–678

    CAS  PubMed  Google Scholar 

  37. Lermann J, Knabl J, Neimann J et al (2020) The work and training situation for young physicians undergoing specialty training in gynecology and obstetrics in Germany: an assessment of the status quo. Arch Gynecol Obstet 302:635–647

    Article  Google Scholar 

  38. Rizzo G et al (2017) Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand 96(8):1006–1011

    Article  Google Scholar 

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Funding

This study was not funded.

Author information

Author notes

  1. Sharon Perlman and Hanoch Schreiber have contributed equally.

Authors and Affiliations

  1. Ultrasound Unit, The Helen Schneider Women’s Hospital, Rabin Medical Center, Zeev Jabotinsky Rd 39, 49100, Petah Tikva, Israel

    Sharon Perlman, Hanoch Schreiber, Ron Bardin & Yinon Gilboa

  2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Sharon Perlman, Hanoch Schreiber, Ron Bardin, Eran Kassif, Reuven Achiron & Yinon Gilboa

  3. Ultrasound Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-HaShomer, Israel

    Zvi Kivilevitch, Eran Kassif & Reuven Achiron

Authors
  1. Sharon Perlman
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  2. Hanoch Schreiber
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  3. Zvi Kivilevitch
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  4. Ron Bardin
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  5. Eran Kassif
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  6. Reuven Achiron
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  7. Yinon Gilboa
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Contributions

SP: project development, data collection and management, data analysis, manuscript writing/editing. HS: data management, data analysis, manuscript writing/editing. ZK: project development, manuscript writing/editing. RB: manuscript writing and editing. EK: manuscript writing and editing. RA: project development, Manuscript writing/editing. YG: project development, data collection and management, data analysis, manuscript writing/editing. Other (please specify briefly using 1–5 words).

Corresponding author

Correspondence to Sharon Perlman.

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Conflict of interest

The authors declared that they have no conflict of interest.

Ethical approval

0828-17-RMC, 7656-10-SMC.

Consent to participate

All patients provided written informed consent to participate in the study.

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Perlman, S., Schreiber, H., Kivilevitch, Z. et al. Sonographic risk assessment for an unplanned operative delivery: a prospective study. Arch Gynecol Obstet 306, 1469–1475 (2022). https://doi.org/10.1007/s00404-022-06413-7

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  • DOI: https://doi.org/10.1007/s00404-022-06413-7

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