Abstract
Objective
The objective was to assess the predictive value of head-perineum distance measured
at the initiation of the active second stage of labor on the mode of delivery.
Material and Methods
It was a prospective cohort study in an academic Hospital of Rennes, France, from
July 1, 2020 to April 4, 2021 including 286 full-term parturients who gave birth to
a newborn in cephalic presentation. A double-blind ultrasound measurement of the head-perineum
distance was performed during the second phase of labor within five minutes after
the onset of pushing efforts. The primary outcome was the mode of delivery (spontaneous
vaginal delivery versus instrumental vaginal delivery or cesarean section). We performed
a multivariate analysis to determine the predictive value of the head-perineum distance
by adjusting on potential confounders.
Results
Overall, 199 patients delivered by spontaneous vaginal delivery, 80 by instrumental
vaginal delivery, and seven by cesarean section. The head-perineum distance measured
at the beginning of pushing efforts was predictive of the mode of delivery with a
threshold at 44 mm (crude: sensitivity = 56.8 % and specificity = 79.3 %; adjusted:
sensitivity = 79.4 % and specificity = 87.4 %). The risk of medical intervention was
higher when the head-perineum distance is>44 mm with an adjusted OR of 2.78 [1.38;
5.76].
Conclusion
The head-perineum distance measured at the initiation of the active second stage of
labor is predictive of the mode of delivery. Head-perineum distance below 44 mm predicts
a vaginal delivery with the best diagnostic performance, and optimizes the time to
start pushing efforts.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: a systematic review and meta-analysis of randomized controlled trials.Am J Obstet Gynecol. 2020; 223: 189-203
- Pushing/bearing down methods for the second stage of labour.Cochrane Database Syst Rev. 2015; : CD009124
- Risk factors for severe perineal trauma during childbirth: an updated meta-analysis.Eur J Obstet Gynecol Reprod Biol. 2020; 247: 94-100
- Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application?.Arch Gynecol Obstet. 2017; 295: 67-73
- Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-year observational review at a tertiary referral centre in London.J Pregnancy. 2015; 2015
- 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: 868-874
- Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor.Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2002; 19: 264-268
- Occiput posterior position diagnosis: vaginal examination or intrapartum sonography? A clinical review.J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2014; 27: 520-526
- Labor progress determined by ultrasound is different in women requiring cesarean delivery from those who experience a vaginal delivery following induction of labor.Am J Obstet Gynecol. 2019; 221: 335.e1-335.e18
- Factors that affect ultrasound-determined labor progress in women undergoing induction of labor.Am J Obstet Gynecol. 2019; 220: 592.e1-592.e15
- Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term.Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2006; 27: 387-391
- Descent of the presenting part assessed with ultrasound.Am J Obstet Gynecol. 2021; S0002–9378: 00964-00969
- Assessment of the angle of progression and distance perineum-head in the prediction of type of delivery and duration of labor using intrapartum ultrasonography.J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021; 34: 2340-2348
- Instrumental delivery with perineum-fetal head distance >55 MM on ultrasound.Gynecol Obstet Fertil. 2016; 44: 82-87
- Indications and prerequisites for operative vaginal delivery: when, how and where?.J Gynecol Obstet Biol Reprod (Paris). 2008; 37: S188-S201
- Factors associated with success or failure in trials of vacuum extraction.Aust N Z J Obstet Gynaecol. 2002; 42: 41-45
- Fetal descent in nulliparous women assessed by ultrasound: a longitudinal study.Am J Obstet Gynecol. 2021; 224: 378.e1-378.e15
- Prediction of spontaneous vaginal delivery in nulliparous women with a prolonged second stage of labor: the value of intrapartum ultrasound.Am J Obstet Gynecol. 2019; 221: 642.e1-642.e13
- Immediate compared with delayed pushing in the second stage of labor A systematic review and meta-analysis.Obstet Gynecol. 2012; 120: 660-668
- Intrapartum ultrasound at the initiation of the active second stage of labor predicts spontaneous vaginal delivery.Am J Obstet Gynecol MFM. 2021; 3
- Prediction of delivery mode with transperineal ultrasound in women with prolonged first stage of labor.Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2011; 37: 702-708
- Ultrasound is better tolerated than vaginal examination in and before labour.Aust N Z J Obstet Gynaecol. 2019; 59: 362-366
- Is intrapartum translabial ultrasound examination painless?.J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2016; 29: 3276-3280
- Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study.Am J Obstet Gynecol. 2017; 217: 69.e1-69.e10
- ISUOG Practice Guidelines: intrapartum ultrasound.Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2018; 52: 128-139
Article info
Publication history
Published online: November 23, 2022
Accepted:
November 21,
2022
Received in revised form:
November 17,
2022
Received:
September 23,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
