Abstract
Introduction
Non-progress of labour forms the largest indication caesarean section. The diagnosis of failure of descent using serial digital examination is objective, poor reproducibility, carries the risk of infection and is painful to the labouring patient. There is a need if not an alternative, adjunctive to digital vaginal examination. Measuring angle of descent (AOD) to predict vaginal birth in late labour by transperineal ultrasound provides an alternative without any of the above-mentioned drawbacks.
Materials and Methods
A prospective observational study in 64 patients in the late first stage and second stage of labour with cephalic presentation was carried out, from September 2017 to December 2018, in PGIMER and DR. RML Hospital. Angle of descent was measured by transperineal ultrasound. Angle of descent is the angle between the longitudinal axis of pubic bone and a line joining the lowest edge of the pubis to the lowest convexity of the foetal skull. Time of assessment of AOD1 was noted, and if patient did not deliver within 2 h, another AOD2 was recorded. Eighty-five readings were obtained, and AOD predicting successful vaginal delivery was calculated.
Results and Discussion
AOD of 116° and more resulted in vaginal delivery, spontaneous or instrumental. As the angle of descent increased, there was a decrease in time interval to vaginal delivery with correlation coefficient of − 0.939.
Conclusion
The use of intrapartum transperineal ultrasound and measurement of angle of descent can prove to be a valuable adjunct in management of labour, especially in cases of prolonged first and second stages of labour in predicting successful vaginal delivery. AOD of 116° or more can predict successful vaginal delivery within 2 h. AOD can be used in centres having facilities of intrapartum ultrasound. The authors recommend the use of ultrasound in labour room as it is non-invasive and can provide a lot of information. This method is currently useful for tertiary centres or medical colleges.
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References
Barbera AF, Pombar X. A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol. 2009;33:313–9. https://doi.org/10.1002/uog.6329.
Omar Khalil. Elbadawiv Elsayed Assessment of the progress of labor by the use of Intrapartum ultrasound. Alex J Med. 2012;48:295–301.
Buchmann E, Libhaber E. Interobserver agreement in intrapartum estimation of fetal head station. Int J Gynaecol Obstet. 2008;101:285–9.
Dupuis O, Silveira R, Zentner A, et al. Birth simulator: reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynaecologists classification. Am J Obstet Gynecol. 2005;192:868–74.
Sherer DM, Miodovnik M, Bradley KS, et al. Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor. Ultrasound Obstet Gynecol. 2002;19:264–8.
Lok ZLZ, Chor MCM. Reliability of digital vaginal examination for fetal head position determination: a prospective observational study. Edorium J Gynecol Obstet. 2015;1:5–9.
Ghi T, Eggebø T, Lees C, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol. 2018;52:128–39.
Eggebø TM, Hassan WA, Salvesen KA, et al. Sonographic prediction of vaginal delivery in prolonged labor: a two-center study. Ultrasound Obstet Gynecol. 2014;43:195–201.
Kalache KD, Duckelmann AM, Michaelis SA, et al. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery? Ultrasound Obstet Gynecol. 2009;33:326–30.
Bultez T, Quibel T, Bouhanna P, et al. Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure. Ultrasound Obstet Gynecol. 2016;48:86–91.
Sainz JA, Borrero C, Aquise A, et al. Utility of intrapartum transperineal ultrasound to predict cases of failure in vacuum extraction attempt and need of cesarean section to complete delivery. J Matern Fetal Neonatal Med. 2016;29:1348–52.
Duckelmann AM, Bamberg C, Michaelis SAM, et al. 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. 2010;35:216–22.
Yuce T, Kalafat E, Koc A. Transperineal ultrasonography for labor management: accuracy and reliability. Acta Obstet Gynecol Scand. 2015;94(7):760–5.
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Hospital ethical committee clearance for study was taken (file no-1776/17 dated 30.10.17).
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Renuka Malik is a Professor and Consultant in Obstetrics and Gynecology in RML Hospital and PGIMER, New Delhi, India. Dr. Swati Singh is a PG Resident in Department of OB-GYN at RML Hospital and PGIMER, New Delhi, India.
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Malik, R., Singh, S. Measurement of Angle of Descent (AOD) by Transperineal Ultrasound in Labour to Predict Successful Vaginal Delivery. J Obstet Gynecol India 70, 126–132 (2020). https://doi.org/10.1007/s13224-019-01300-9
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DOI: https://doi.org/10.1007/s13224-019-01300-9