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Ultrasound image and drawing to demonstrate the fetal head direction described as the angle between a vertical line from inferior apex of the symphysis (yellow line) and another line drawn perpendicular to the widest diameter of the fetal head (red line).
Source publication
Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for ces...
Context in source publication
Context 1
... studies have used ultrasound to provide an ob- jective measure of head progression in labor [16] . Head direction was defined by Henrich et al. [17] as the angle between the infrapubic line of the pelvis (a line perpen- dicular to the longer diameter of the pubis starting from the inferior border) and another line drawn perpendicu- lar to the widest diameter of the fetal head ( fig. 1 ). Using this technique, three types of head direction were deter- mined: head down, horizontal and head up. 'Head up' is when the line drawn perpendicular to the widest diam- eter of the fetal head points ventrally at an angle of 6 30°; head down is when this angle is ! 0°; all other angles are considered 'horizontal'. The head direction together with the descent in the maternal pelvis is a good indicator of successful vaginal delivery. An upward direction of the fetal head is a sign of good prognostic value for vaginal delivery contrary to a downward or horizontal direction of the ...
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Abstract Background In India, 3.6 million pregnancies are affected by preterm birth annually, with many infants dying or surviving with disability. Currently, there is no simple test available for screening all women at risk of spontaneous PTB in low income setting, although high resource settings routinely use cervical length measurement and cervi...
Objective:
To assess the prediction of delivery within 7 days in pregnant women who showed symptoms of spontaneous preterm birth (PB) by means of fetal adrenal gland biometry and to compare these predictions with the cervical length (CL) measurement.
Methods:
We performed a prospective cross-sectional study with 53 pregnant women between 24 and...
Background
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Does screening help to decrease the rate of preterm delivery and preeclampsi...
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The fetal fibronectin test is advocated to facilitate the management of women presenting with threatened preterm labour, but is underutilised in Hong Kong. This study aimed to provide experience with this test and evaluate its utility in a local setting.
Design:
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Setting:
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To determine the correlation between transabdominal (TA) and transvaginal (TV) cervical length measurement in a low-risk obstetric population in Taiwan.
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Citations
... Over the last 30 years, the value of ultrasound screening in the prenatal diagnosis of fetal abnormalities and the assessment of fetal growth and wellbeing has undoubtedly been demonstrated [8]. Nowadays, in many countries, prenatal screening tests are offered to pregnant women as part of standard prenatal care. ...
Introduction: Breaking bad news is one of the most difficult responsibilities in medical practice. Although medical staff in clinical practice often encounter situations that necessitate the announcement of unpleasant news, there is a lack of training regarding their communication with patients and their families. Effective interaction between medical staff and pregnant women constitutes a crucial component of breaking down unpleasant news. This research aimed to investigate the knowledge and attitude of health professionals, particularly obstetricians, and midwives, regarding the announcement of bad news during prenatal screening.
Methods: The study was conducted between September 2017 and April 2018. One hundred professional obstetricians and midwives involved in fetal and prenatal medicine in Greece were part of the study. The study consisted of two parts: the first covered the emotional state of healthcare professionals during the announcement of unpleasant news, and the second covered the appropriate way to inform unpleasant results during prenatal testing.
Results: In this study, only 41% of the participants considered that they felt comfortable discussing issues related to the diagnosis of an unpleasant result during prenatal testing with the pregnant woman/patient, or her relatives, and 85% accepted that they had experienced feelings of sadness, anxiety, or guilt when announcing unpleasant results. Furthermore, 87% of the participants believed that the non-verbal communication component (eye contact, body language) plays an important role in breaking bad news. Finally, 65% considered that prolonged monitoring of the ultrasound screen during prenatal screening does not increase the anxiety of pregnant women when carried out for a better medical opinion.
Conclusions: Delivering bad news during prenatal screening creates stress for the parents. As far as the ethical, cultural, psychological, and legal complicity of healthcare professionals is concerned, communicating unpleasant news has been a subject of discussion by many experts. It is important to understand the concerns of women regarding the risks of counseling.
... Ultrasound is performed to confirm the correct positioning of the device in relation to the spina iliaca of the pelvis [71]. ...
Background
Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure.
Methods
Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.
Results
Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.
Conclusion
This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.
... 3,4 For all these reasons, ultrasound has emerged as a well-tolerated, complementary and valuable non-invasive technique for assessing labor progress objectively, reproducibly, confidently, and safely. [5][6][7] In addition, ultrasound can objectively assess fetal presentation, placenta localization, and is also a helpful tool for evaluating fetal heart rate, evaluating cervical dilatation (CD), or assisting the vaginal birth of the second twin. 8,9 Labor progress by ultrasound is assessed with parameters that correlate the anatomical landmarks of the pelvis with the fetal head. ...
Objective
To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training.
Methods
In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head‐to‐perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position.
Results
We found a good correlation between the AoP measured by obstetricians and midwives (intra‐class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80–0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68–0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91–0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80–0.98).
Conclusions
Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.
... However, digitally assessed head station during intrapartum period many times is erroneous, inaccurate and not consistently reproducible by different examiners. 5 In fact, intrapartum ultrasound examination is more specific and correlates well with different sonographers, and there is a significant disagreement between vaginally performed assessment and ultrasound assessment. 6 Though it appears that transperineal ultrasound assesses head to perineum distance more objectively, it cannot completely replace the role of vaginal examination in labour. ...
Background: Induction of labor (IOL) is one of the most frequent obstetric procedures require for various obstetrics indications in 13-20% of term. Traditionally success of induction has been determined by Bishop score, but this score is observer based and significant inter observer disagreements have been noted. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. So in this study we did ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery. Methods: All eligible women who are planned for induction of labour will undergo ultrasound assessment of foetal head–perineum distance prior to induction of labour. Transvaginal ultrasound will also be performed using ultrasound probe to measure cervical length. After the scans, prevaginal examination will be performed to assess the various components of modified Bishop score (min 0, max 10). If cervix is found unfavourable, induction of labour will be done. If patient did not go into active labour, then induction will be considered unsuccessful) or else oxytocin drip in cases where cervix is found favourable. The patients will be followed up till delivery. Results: Out of 125 patients enrolled for the study, 101 women delivered successfully vaginally and 24 had to undergo caesarean delivery. Of these 24 cases of caesarean delivery, 11 cases were excluded as the operative procedure was performed for indication not related to unsuccessful induction such as occurrence of foetal distress in labour, thick meconium-stained liquor with unfavourable cervix. The final analysis was performed from 114 subjects (101 vaginal births and 13 caesarean births). Conclusions: Transperineal fetal head–perineum distance is less painful as less time consuming and less acceptable by patients compare to Transvaginal measurement of cervical length and painful digital examination for bishop score.
... Therefore since recently, use of intrapartum ultrasonography has come into play as an indication for assessment of fetal malposition [9]. Usefulness of measuring various parameters such as angle of progression, progression distance, head-symphysis distance during second stage of labour has been evaluated and found to be effective in predicting of the labour outcome [10][11][12]. ...
... Traditionally, degree of fetal head deflexion has been assessed by vaginal examination and has been used as parameter to predict the progression and the outcome of labour. Since recent advancements, trans-abdominal and trans-perineal ultrasonography have been identified as useful to predict labour outcome, but most are assessed at second stage [10][11][12][13]. ...
Introduction: Fetal head deflexion plays an important role during the labour process and predicts the outcome of labour. Though traditionally it was assessed via digital examination, recent advancements in medicine have shown ultrasonographic parameters might be useful to measure of head flexion via fetal occiput-spine angle (OSA). Aim of this study was to evaluate its role. Method: We conducted a cross-sectional observational study on 292 uncomplicated singleton pregnant mothers without occiput posterior position. At early active phase of labour (OS= 4 – 6cm), angle between two tangential lines to the occipital bone and the vertebral body of the first cervical vertebra was measured as OSA. Labour progression and mode of delivery was monitored. Association between OSA and labour outcome along with the inter-observer difference was evaluated. Results: The mean OSA value was 133.88 ± 7.39°. The OSA measurement showed good inter-observer agreement (r = 0.99; p<0.001). The mean OSA was significantly less for the group of patients who had to undergo operative delivery (instrumental and cesarean) due to labour dystocia (n=37) as compared to women who had vaginal delivery (n=251), (128 ± 7.28° vs 134.83 ± 6.97°, P<0.001). The mean OSA was significantly greater for the group of patients who had a normal labour progression (n=32) as compared to women who had an abnormal progression (n=260), (134.67 ± 7.06° vs 127.47 ± 6.99°, P<0.001). Sonographic assessment of deflexion using OSA was found to be an independent predictor of labour outcome according to multivariate regression analysis. OSA value less than 127.8° was associated with abnormal labour progression and operative delivery with a good sensitivity of 86.5% & 85% respectively. However negative predictive value for operative delivery being 6.8%, suggests that multiple clinical parameters should be considered when the decision of caesarean section is made. Conclusion: Sonographic assessment of fetal head deflexion during early active phase can be used as reproducible, feasible screening parameter to predict labour progression and mode of delivery. Decision for operative delivery should be made using multiple clinical assessments.
... For centuries, the different methods of antenatal assessment of the pelvis have produced varying results. These methods include manual pelvimetry, instrumental pelvimetry, radiological pelvimetry, magnetic resonance imaging, and computed tomodensitometry (CT) (Hamm & Forstner, 2007;Lenhard et al., 2010;Molina & Nicolaides, 2010). Previous studies have shown that CT is convenient and accurate technique to measure the obstetrical external pelvic diameters (Kolesova et al., 2017;Siccardi et al., 2019), yet this technique is not available in rural areas in DRC . ...
While globally, many efforts have been deployed to improve access to and use of surgical services to reduce the burden of female genital fistula; there still remain challenges about the health of women after surgical repair of fistula. This chapter provides new insights on the matter using our experience from Guinea. Using mixed methods approaches, I analyze the findings from a longitudinal study with 481 women discharged from hospital with a closed fistula (the biggest cohort of its kinds to date) to assess health outcomes including recurrence of fistula, pregnancy, and pregnancy outcomes for the mother and the child. I then use the data from two qualitative studies conducted at national level with various stakeholders to complete the analysis. One study explores the perceptions of these stakeholders on women’s health after obstetric fistula repair. The second study describes the social reintegration of women after surgical repair along with describing the experiences of various stakeholders involved in the reintegration process. By triangulating the findings of these three studies, this chapter provides a more comprehensive understanding of the current situation in Guinea and sheds light on the necessary challenges that need to be addressed toward a fistula-free generation.KeywordsObstetric fistulaSocial reintegrationReproductive healthWomenPostfistula repairGuinea
... The most common sonographic pelvic floor changes are increases in urethro-vesical angle, urethral mobility, detrusor muscle thickness and hiatal dimensions as well as levator ani injuries which are connected to PFDs in pregnancy [4]. In addition to its use in pelvic floor dysfunctions, transperineal ultrasonography is also commonly used in many different indications such as labor management [5], obstetric tears [6], outcomes of mid-urethral tape surgery [7] and so on. ...
Background: Pelvic floor dysfunctions (PFDs) are commonly encountered in pregnancy, which may include urinary and fecal incontinence, pelvic pain, sexual dysfunction and pelvic organ prolapse. Identifying these problems and their risk factors in pregnancy is crucial for prevention and management. The primary outcome of this study is to investigate the relationship between the PFD symptoms in pregnant women and perineal ultrasonography measurements. Secondary outcomes are to figure out the risk factors for PFDs in pregnancy and also to identify the relationship between these risk factors with transperineal ultrasonography measurements and pelvic floor muscle strength (PFMS).
Methods: 49 pregnant women recruited in the study, were asked to fill questionnaires, underwent transperineal ultrasonography and pelvic floor muscle strength examination.
Results: The hiatal area at rest, pelvic contraction and Valsalva are posi- tively correlated with stress urinary incontinence (SUI) (p = 0.018, p = 0.003 and p = 0.006 respectively), pelvic organ prolapse (POP) (p = 0.015, p = 0.022 and p = 0.011 respectively) and sexual dysfunction (SD) (p = 0.033, p = 0.041 and p = 0.023 respectively). Hiatal area at Valsalva and detrusor muscle thickness are positively correlated with urge urinary incontinence (UUI) (p = 0.021 and p = 0.012). The hiatal area value at pelvic contraction and Valsalva are positively correlated with feacal/flatal incontinence (FFI) (p = 0.024 and p = 0.037). Hiatal areas at rest, pelvic contraction, Valsalva and detrussor muscle thickness are correleated with age (r = 0.287, r = 0.335, r = 0.315 and r = 0.421 respectively), body mass index (r = 0.380, r = 0.420, r = 0.415 and r = 0.447 respectively) and pelvic floor muscle strength (r = –0.539, r = –0.583, r = –0.550 and r = –0.545 respectively). Bladder neck descent is correlated with body mass index (r = 0.284).
Conclusions: Transperineal ultrasound measurements of Detrusor muscle thickness, hiatal area (HA) at rest, pelvic contraction and Valsalva Manoeuvre are found to be associated with PFDs in pregnant women. Risk factors for PFDs in pregnancy are body mass index, age, gestational week, parity, birth weight and delivery method.
Keywords: fecal incontinence; pelvic floor dysfunction; pelvic floor disorders; pelvic floor ultrasonography; pelvic organ prolapse; translabial ultrasonography; transperineal ultrasonography; pregnancy; sexual dysfunction; urinary incontinence
... The use of transperineal ultrasound has been used for several aspects of woman pelvis, from surgical follow up of genital prolapse to labor [1,2]. Pelvic floor ultrasound has demonstrated usefulness for the diagnosis of pelvic organ prolapse (POP). ...
We want to describe a model that allows the use of transperineal ultrasound to define the probability of experiencing uterine prolapse (UP). This was a prospective observational study involving 107 patients with UP or cervical elongation (CE) without UP. The ultrasound study was performed using transperineal ultrasound and evaluated the differences in the pubis–uterine fundus distance at rest and with the Valsalva maneuver. We generated different multivariate binary logistic regression models using nonautomated methods to predict UP, including the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver. The parameters were added progressively according to their simplicity of use and their predictive capacity for identifying UP. We used two binary logistic regression models to predict UP. Model 1 was based on the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient [AUC: 0.967 (95% CI, 0.939–0.995; p < 0.0005)]. Model 2 used the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver, age, avulsion and ballooning (AUC: 0.971 (95% CI, 0.945–0.997; p < 0.0005)). In conclusion, the model based on the difference in the pubis–uterine fundus distance at rest and with the Valsalva maneuver and the age of the patient could predict 96.7% of patients with UP.
... Over the recent years, the use of ultrasound contributed considerably to our understanding of the mechanism of labor [1][2][3][4]. Transabdominal ultrasound offers an accurate tool for fetal occiput position determination [5][6][7][8][9][10][11]. The transperineal approach can be used to objectively and reliably assess the fetal head descent in the birth canal [12][13][14][15][16][17][18]. ...
Objective:
To assess the correlation between fetal head regression and levator ani muscle (LAM) co-activation under Valsalva maneuver.
Study design:
This study was a secondary analysis of a prospective cohort study on the association between the angle of progression (AoP) and labor outcome. We scanned a group of nulliparous women at term before the onset of labor at rest and under maximum Valsalva maneuver. In addition to the previously calculated AoP, in the present study, we measured the anteroposterior diameter of LAM hiatus (APD) on each ultrasound image. LAM co-activation was defined as APD at Valsalva less than that at rest, whereas fetal head regression was defined as AoP at Valsalva less than that at rest. We calculated the correlation between the two phenomena. Finally, we examined various labor outcomes according to the presence, absence, or co-existence of these two phenomena.
Results:
We included 469 women. A total of 129 (27.5%) women presented LAM co-activation while 50 (10.7%) showed head regression. Only 15 (3.2%) women showed simultaneous head regression and LAM co-activation. Women with coexisting LAM co-activation and head regression had the narrowest AoP at Valsalva in comparison with other study groups (p < .001). In addition, they had the highest risk of Cesarean delivery (40%) and longest first, second, and active second stage durations, although none of these reached statistical significance.
Conclusion:
In nulliparous women at term before the onset of labor fetal head regression and LAM co-activation at Valsalva are two distinct phenomena that uncommonly coexist.
... Intrapartum ultrasound allows objective and reproducible measurement of labor parameters and is comparable to digital vaginal examination, is noninvasive and does not cause discomfort (16,17) . With increasing resolution and easier accessibility, ultrasound is used for fetal head status (engagement, station, and position), cervical status (shortening and dilatation) and ...
Objectives: Cervical effacement and dilatation, station of the presenting part, and fetal head position
are the key determinants of progress of labor. There is growing evidence about the usefulness
of intrapartum ultrasound in evaluating the labor parameters objectively to decide about the
labor management. Hence, intrapartum translabial ultrasound was studied to predict the mode
of delivery.
Materials and Methods: 185 laboring women with singleton pregnancy, term gestation, and cephalic
presentation with 4 cm. cervical dilatation were included. Intrapartum translabial ultrasound was
done to note angle of progression (AoP), cervical length, and position of the fetal head.
Results: Among 185 women, 121 (65.4%) had vaginal (112 normal and 9 assisted vaginal) and 64
cesarean (34.6%) delivery. An angle of progression of 89o
with area under the curve (AUC)
0.789 (p ≤ 0.0001) measured in the early active phase of labor had a sensitivity, specificity,
positive predictive value and negative predictive value of 79.3% and 65.6%, 81.3% and 62.7%
respectively. The positive likelihood ratio and the negative likelihood ratio were 2.3 and 0.315,
respectively. The clinical utility index for AoP was 0.644 in predicting the mode of delivery. AUC
for cervical length was 0.534 (p = 0.452), which was not significant. The odds ratio for
occipitoanterior position in predicting vaginal delivery was 3.9.
Conclusion: Intrapartum translabial ultrasound is a reproducible and feasible method to evaluate
labor parameters. Assessing multiple components like the angle of progression, cervical length,
and position of the fetal head in early labor could help to predict the mode of delivery.
Keywords: angle of progress
