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Predictive value of head-perineum distance measured at the initiation of the active second stage of labor on the mode of delivery: a prospective cohort study

Published:November 23, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.020

      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 is higher when the head-perineum distance is greater than 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 44mm predicts a vaginal delivery with the best diagnostic performance, and optimizes the time to start pushing efforts.

      Keywords

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