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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Article Info
Publication History
Accepted:
November 21,
2022
Received in revised form:
November 17,
2022
Received:
September 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier B.V.
