Angle of Progression on Ultrasound in the Second Stage of Labor and Spontaneous Vaginal DeliveryFunding None.
11 August 2017
30 September 2017
07 November 2017 (eFirst)
Objective The objective of this study was to assess the association between the angle of progression (AoP) measured by transperineal ultrasound and mode of delivery and duration of the second stage.
Study Design This is a prospective observational study of nulliparous women with a singleton gestation at term in which serial transperineal ultrasound examinations were obtained during the second stage of labor. Multivariable logistic regression and adjusted survival models were used for the analysis.
Results A total of 137 patients were included in the analysis and median AoP for the study group was 153 degrees. The adjusted odds ratio (aOR) of requiring an operative delivery was 2.6 times higher for those patients who had an AoP < 153 degrees and the aOR of requiring a cesarean delivery was almost six times higher when compared with those patients who had an AoP ≥ 153 degrees (95% confidence interval [CI]: 1.0, 6.2; p = 0.04; aOR: 5.8, 95% CI: 1.2–28.3; p = 0.03, respectively). Those patients with an AoP < 153 degrees were at a higher hazard of staying pregnant longer (adjusted hazard ratio: 1.8, 95% CI: 1.2–2.8, p = 0.005).
Conclusion The AoP has the potential to predict spontaneous vaginal delivery and the duration of the second stage of labor which may be useful in counseling patients and managing their labor.
Keywordsangle of progression - operative delivery - second stage of labor - spontaneous vaginal delivery - transperineal ultrasound
The angle of progression has the potential to predict the mode of delivery and duration of the second stage which may be useful in counseling patients and managing their labor.
The study was performed at the Brigham and Women's Hospital, Boston, MA. These findings were presented as a poster at the 37th Annual Scientific Meeting of the Society for Maternal Fetal Medicine on January 28, 2017, Las Vegas, NV.
- 1 Cheng YW, Hopkins LM, Caughey AB. How long is too long: does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol 2004; 191 (03) 933-938
- 2 Le Ray C, Audibert F, Goffinet F, Fraser W. When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. Am J Obstet Gynecol 2009; 201 (04) 361.e1-361.e7
- 3 Allen VM, Baskett TF, O'Connell CM, McKeen D, Allen AC. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol 2009; 113 (06) 1248-1258
- 4 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 Gynecologists classification. Am J Obstet Gynecol 2005; 192 (03) 868-874
- 5 Sherer DM, Abulafia O. Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations. Ultrasound Obstet Gynecol 2003; 21 (05) 430-436
- 6 Dupuis O, Ruimark S, Corinne D, Simone T, André D, René-Charles R. Fetal head position during the second stage of labor: comparison of digital vaginal examination and transabdominal ultrasonographic examination. Eur J Obstet Gynecol Reprod Biol 2005; 123 (02) 193-197
- 7 Akmal S, Tsoi E, Kametas N, Howard R, Nicolaides KH. Intrapartum sonography to determine fetal head position. J Matern Fetal Neonatal Med 2002; 12 (03) 172-177
- 8 Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003; 21 (05) 437-440
- 9 Barbera AF, Pombar X, Perugino G, Lezotte DC, Hobbins JC. A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol 2009; 33 (03) 313-319
- 10 Dückelmann AM, Bamberg C, Michaelis SA. , 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 (02) 216-222
- 11 Ghi T, Youssef A, Maroni E. , et al. Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery. Ultrasound Obstet Gynecol 2013; 41 (04) 430-435
- 12 Kalache KD, Dückelmann AM, Michaelis SA, Lange J, Cichon G, Dudenhausen JW. 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 (03) 326-330
- 13 Molina FS, Terra R, Carrillo MP, Puertas A, Nicolaides KH. What is the most reliable ultrasound parameter for assessment of fetal head descent?. Ultrasound Obstet Gynecol 2010; 36 (04) 493-499
- 14 Rayburn WF, Siemers KH, Legino LJ, Nabity MR, Anderson JC, Patil KD. Dystocia in late labor: determining fetal position by clinical and ultrasonic techniques. Am J Perinatol 1989; 6 (03) 316-319
- 15 Eggebø TM, Gjessing LK, Heien C. , et al. Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term. Ultrasound Obstet Gynecol 2006; 27 (04) 387-391
- 16 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 17 Marsoosi V, Pirjani R, Mansouri B. , et al. Role of ‘angle of progression’ in prediction of delivery mode. J Obstet Gynaecol Res 2015; 41 (11) 1693-1699
- 18 Kameyama S, Sato A, Miura H. , et al. Prediction of spontaneous vaginal delivery by transperineal ultrasound performed just after full cervical dilatation is determined. J Med Ultrason (2001) 2016; 43 (02) 243-248
- 19 Ciaciura-Jarno M, Cnota W, Wójtowicz D. , et al. Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery. Ginekol Pol 2016; 87 (06) 448-453
- 20 Ghi T, Maroni E, Youssef A. , et al. Sonographic pattern of fetal head descent: relationship with duration of active second stage of labor and occiput position at delivery. Ultrasound Obstet Gynecol 2014; 44 (01) 82-89
- 21 Yonetani N, Yamamoto R, Murata M. , et al. Prediction of time to delivery by transperineal ultrasound in second stage of labor. Ultrasound Obstet Gynecol 2017; 49 (02) 246-251