Abstract
To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery. In this prospective study, nulliparous women were recruited at 37.0-42.0weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD. Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118. Sonographic parameters representing maternal pelvic configuration (PAA) and maternal-fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.
Highlights
Despite significant advances in modern medicine, prelabor prediction of an obstructed labor and unplanned operative delivery (UOD) and its consequences [1] remains an unsolved challenge
Sonographic parameters representing maternal pelvic configuration (PAA) and maternal-fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery
In the unplanned operative delivery group, successful operative vaginal delivery occurred in 36 women (15.4%) and cesarean delivery in 23 (9.8%)
Summary
Despite significant advances in modern medicine, prelabor prediction of an obstructed labor and unplanned operative delivery (UOD) and its consequences [1] remains an unsolved challenge. The first two parameters can be estimated and quantified before labor onset and can be used as personal predictive factors [2,3,4,5,6,7,8]. The continuing effort to search for objective risk assessment, parallel with the introduction of ultrasonography equipment into the delivery rooms, has led to many reports regarding the value of various sono-pelvimetric parameters in predicting dysfunctional labor and unplanned operative delivery [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. The angle of progression, widely reported in the literature as a predictive measurement when obtained before the onset of labor, during the first and second stages of labor, and before assisted delivery, represents the fetal head station. The pubic arch angle (PAA), reported by our group [24,25] and others [26,27,28,29,30,31,32,33] to have a strong negative correlation with persistent occiput posterior and mode of delivery, represents the primary pelvimetric diameter of the pelvic outlet
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