Prediction of vaginal deliveries using fetal head descent assessed by transperineal ultrasound

Abstract

This study evaluated the use of transperineal ultrasound for predicting successful vaginal deliveries. This was a prognostic cohort design study conducted between March and May 2016 at the Karawang District Hospital, Indonesia. Inclusion criteria were term pregnancy, singleton live birth with head presentation, and active phase of labor. The fetal head-to-perineum distance and the angle of progression in the relaxation phase and between contractions were assessed by transperineal ultrasound. Data were analyzed using the Mann–Whitney U test, and the optimal cut-off was determined using receiver operating curves (ROC). A total of 306 women delivered vaginally during the study period. The cut-off for fetal head-to-perineum distance as a predictor of vaginal delivery was 43.5 mm (sensitivity, 91%; specificity, 78%), with an area under the curve of 82% (95% confidence interval [CI], 69%–95%; p < 0.01); the angle of progression was 107° (sensitivity, 80%; specificity, 97%), with an area under the curve of 96.4% (95% CI, 87%–99%, p < 0.01). In conclusion, fetal head-to-perineum distance and angle of progression can predict the success of vaginal deliveries.