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Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor

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

Abstract

Purpose

To determine the validity of intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor.

Methods

Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3 h (“prolonged”) and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in “prolonged” second stage to predict a vaginal delivery (VD) was assessed. Fetal head descent, measured by AOP change/h (calculated from serial measurements), was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent.

Results

Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153° ± 19 vs. 133° ± 17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127° was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1° ± 11.4° vs. 6.2° ± 6.3°, p <  0.001).

Conclusion

Ultrasound-assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting the mode and interval time to delivery in real-life clinical practice.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Author notes

  1. Edi Vaisbuch and Roni Levy contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kaplan Medical Center, 76100, Rehovot, Israel

    Tamar Katzir, Yoav Brezinov, Ella Khairish, Shira Hadad, Edi Vaisbuch & Roni Levy

  2. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Edi Vaisbuch & Roni Levy

Authors
  1. Tamar Katzir
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  2. Yoav Brezinov
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  3. Ella Khairish
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Contributions

TK: data collection, data analysis, manuscript writing. EV: project development, protocol development, data analysis, manuscript editing. YB: data collection. EK: data collection. SH: data collection. RL: project development, protocol development, data analysis, manuscript editing.

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Correspondence to Roni Levy.

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The authors report no conflicts of interest in this work.

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Ethical approval was waived by the local Ethics Committee of Kaplan Medical Center, in view of the retrospective nature of the study and all the procedures performed were part of the routine care.

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Katzir, T., Brezinov, Y., Khairish, E. et al. Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor. Arch Gynecol Obstet 307, 763–770 (2023). https://doi.org/10.1007/s00404-022-06469-5

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  • DOI: https://doi.org/10.1007/s00404-022-06469-5

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