Fetal Head Engagement Research Articles

Emerging potential of Matra Basti in facilitating engagement of fetal vertex in primigravidae: A case series

Abstract Although the association between fetal head engagement and normal vaginal delivery is debated, reports indicate that nulliparous women with an unengaged fetal head at term are more likely to require a cesarean section. Acknowledging that engagement is the first step in the mechanism of labor, it is clear that labor cannot progress without passing through the engagement phase. The aim and objective of this study are to evaluate the role of Matra Basti in the engagement of fetal vertex in primigravidae women. A prospective case study was carried out with five primigravidae women who presented at a gestational age of 34 weeks or more with a floating fetal vertex, with five-fifths to four-fifths part of the fetal head palpable above the pelvic brim, and who met the inclusion criteria. The cephalic presentation was confirmed with recent ultrasound findings, while the engagement of the vertex was assessed clinically by abdominal in fifths. Matra Basti with Shudha Bala (Sida cordifolia Linn.) Taila was administered to the five enrolled cases after the completion of 35 weeks of gestation, as per protocol. All five cases showed fetal head engagement following the administration of a minimum of one to a maximum of three sittings (average of 2) of Matra Basti at an average gestational age of 37 weeks. All the cases resulted in uneventful vaginal deliveries without any intrapartum or postpartum feto-maternal complications. The present study offered a favorable outcome in terms of engagement of the fetal vertex and subsequent uneventful vaginal delivery, suggesting the potential of Matra Basti in facilitating the engagement of an unengaged vertex in primigravidae.

Internal manual rotation in intrapartal arrest of fetal head engagement

ObjectiveThe success of internal manual or digital rotation of the head in mechanical dystocia due to malpresentation, malposition or malrotation is presented in this paper on our own clinical material with reference of today's research and clinical recommendations. Study designThrough a retrospective bicentric clinical study, we investigated the success of internal head rotation in two University Clinics for gynecology and obstetrics from year 2017 to 2023. In 152 singleton term (37–42 weeks) in cases of persistens intrapartum arrest of the fetal head. After palpatory and ultrasonographically verified arrest of fetal head engagement, a therapeutic manual (Liepmann) or digital rotation was performed. ResultsIn 152 cases, manual rotation was performed in 108 (71.05 %) and digital rotation in 44 (28.94 %) cases in 73 (48.02 %) primiparous and 79 (51.97 %) multiparous. Intrapartum identification by digital palpation was done in all cases, and the following are: persistent occipital posterior position in 68 (44.73%), persistent deep transverse head presentation in 12 (7.89%), persistent high (longitudinal) occipital presentation in 64 (42.10 %) and persistent anterior asynclitism in 8 (5.26 %) cases. Episiotomy was used in 36 (23.68%) cases. Vacuum extraction was completed in 14 (9.21 %) deliveries, and cesarean section due to unsuccessful internal rotation in 15 (9.8 %) cases (%) without other indication. We did not record any intrapartum complications or cardiotocographic abnormalities. Cervical lacerations were treated with sutures in 4 cases (2.63 %). Successful correction of internal rotation procedure with spontaneous vaginal delivery was found in 80.92 % of cases. If we exclude delivery assisted by vacuum extraction whose indications were fetal hypoxia or dystocia after successful internal head rotation procedure, then the success rate of this method was 90.13 %. ConclusionInternal head rotation is a simple, safe and successful obstetric manual intervention that directly increases the rate of vaginal deliveries after correction of the birth mechanism anomaly and directly reduces the percentage of cesarean section. Manual or digital head rotation is an established midwifery/obstetric skill in several centers which, based on numerous clinical researches and experience, should become protocolized and included in the guidelines of professional associations.

OP01.01: A test on concept pilot study on fetal head engagement by direct visualisation via transabdominal scan

OP01.01: A test on concept pilot study on fetal head engagement by direct visualisation via transabdominal scan

Labor outcome in women by measuring foetal head to perineal distance by transperineal ultrasound

Introduction: Some of the term gestations will need induction of labor due to various reasons. The outcome of these pregnancies is not known beforehand. Engagement of fetal head is assessed clinically by abdominal and vaginal examination, but clinical assessment is a poor predictor for the course of labor Per vaginal examinations are done after induction/active labor for assessment of progression of labor and bishop score calculation, but this score varies from examiner to examiner. With advancement in technology there are improved procedures to assess the progression of labor by measuring foetal head to perineal distance by trans perineal ultrasound. The Trans perineal ultrasound is simple easy, reliable and done only once prior to the induction or augmentation of labor. This can be used to remove the observer bias in per vaginal examination and also multiple per vaginal examinations can also be avoided. The aim of the study is to measure the foetal head to perineal distance by transperineal ultrasound prior to induction or augmentation of labor for better outcome.Methods & Methodology: Prospective study done over18 months with sample size of 150 pregnant women with singleton pregnancy in cephalic presentation at 38 or more than 38 weeks period of gestation planning for induction or in early labor at Dr. PSIMS & RF.Result: In our study 150 pregnant women with singleton pregnancy, cephalic presentation at or more than 38 weeks period of gestation prior to induction or augmentation of labor in patients with FHPD < 7cm 95.24% had vaginal deliveries and 4.76% has caesarean section in patients with FHPD > 7 cm had 22.2%vaginal deliveries, 55% caesarean section, 22.22% instrumental deliveries.Conclusion: In this study it is seen that FHPD has more predictability than bishop score when measured at 38 or more than 38 weeks period of gestation planning for induction or in early labor but Pelvic examinations are mandatory to rule out the colour of liquor in foetal distress or cord prolapse.In settings where the relevant technology and experience are available, foetal head to perineal distance can be utilised as an adjunct method to bishop score in predicting the mode of delivery and in selecting patients for trail of labour.

Outcome of Unengaged Fetal Head at Term in Nullipara

Introduction: Engagement of fetal head is usually regarded as a phenomenon of labor in nullipara. It commonly occurs during the last few weeks in nullipara, in majority by 38 weeks or even during the first stage of labor. The aim of this study was to determine the outcome of unengaged fetal head at term in nullipara. Materials And Methods: This study was conducted at obstetrics and gynecology unit, tertiary care teaching hospital, Peshawar. This was a descriptive cross-sectional study which was conducted during 12th Jan 2021 to 10th April 2022, in which a total of 111 patients were included in the study using 16.89% proportion of caesarean section¸95% confidence level and 7% margin of error under WHO software for sample size determination. Results: In this study, patients were in age range 19-35 years and heights of the patients were 140-160cm. Among 111 patients, normal vaginal delivery occurred in 71.71% patients, instrumental delivery in 10.8% and 18.2% patients underwent low segment caesarean section. Total number of nullipara with unengaged head were divided into four groups based on fetal head station in early labor. Total number of nullipare in each group of which 30.6% were free head, 43.2% at -3 station group, 21.62%-2 station group and 45% in -1 group Practical implication in nulliparous patients a high station at the onset of labour is not necessarily an omnious finding, even though the incidence of arrest disorders are higher when station is -3,or floating ,obstetricians can still be optimistic towards vaginal delivery. Conclusions: Nullipara with unengaged head at term during labors should be regarded with suspicion and as such should be regarded with apprehension in labor. Dysfunctional labor occurs in only small proportion of patients with unengaged head. It is concluded that the incidence of active surgical intervention in nullipara with unengaged fetal head at term is quite high. Keywords: Primigravidae, engagement of head, delivery, LSCS, Head station.

Role Of Transperineal Ultrasound In Assessment Of Fetal Head Engagement As Indication Of Caesarean Section Taking Mode Of Delivery As Gold Standard

The frequency of caesarean sections has been gradually increasing in the past several decades. The usage of transperineal ultrasound (TPU) has been increasing. Many studies have demonstrated that TPU can provide valuable information for the clinician. Objective: To assess the role of transperineal ultrasound in fetal head engagement as indication of caesarean section taking mode of delivery as gold standard. Methods: A cross-sectional study was carried out in Radiology Department of Nawaz Medicare and DHQ hospital, Faisalabad. Written consent was taken from all patients before the ultrasound examination. Patients were assessed for eligibility in inclusion criteria. Confirmation of intrauterine living pregnancy, placenta site, fetal presentation, liquor amount and gestational age was done with routine obstetric ultrasound. Enrolled pregnant patients at term were assessed for the fetal head-perineal distance and cervical length by TPU examination. Results: One hundred and twenty-four (124) women participated in the investigation. Maternal age and gestational age were not determinants of outcomes of labor. Fetal head-perineal distance measured by TPU had a test sensitivity of 88.31 %, specificity of 78.72 %, the positive predictive value is 87.18%, the negative predictive value is 80.43% and diagnostic accuracy is 84.68%. Conclusions: The findings of this study shows that head perineal distance measured by TPU have higher sensitivity and is a non-invasive method which provides valuable objective measurements for fetal head engagement in primigravida at term and can be easily accepted and tolerated by women. Also, unnecessary caesarean section rate can be reduced by timely decision.

Uncertain fetal head engagement: a prospective randomized controlled trial comparing digital exam with angle of progression

Uncertain fetal head engagement represents 4% of obstetrical situations associated with an increased risk of postpartum hemorrhage, notably in cases of cesarean delivery and increased neonatal impairment owing to failed vaginal instrumental delivery. In this obstetrical condition, cesarean delivery is recommended, but vaginal delivery is possible in two-thirds of the cases. During the second stage of labor, the descent of the fetal head can be assessed by sonography, particularly by measuring the angle of progression. To evaluate, after a prolonged second stage of labor, the impact of measuring the angle of progression in addition to a digital examination on cesarean delivery rates when fetal head engagement remains uncertain. This open multicenter randomized pragmatic trial included women at term with a singleton cephalic fetus in a clinical occiput anterior position after a prolonged 2-hour second stage of labor with uncertain fetal head engagement. After inclusion in the study, an independent investigator performed ultrasound systematically to confirm the occiput anterior position and measured the angle of progression at the climax of Valsalva pushing. This operator did not participate in labor management. In the study group but not in the control group, the angle of progression was communicated to the obstetrician in charge of labor management. Obstetricians were encouraged to attempt vaginal birth if the angle of progression was >120°. The primary outcome was the cesarean delivery rate. Secondary outcomes were operative delivery rate (cesarean delivery and operative vaginal delivery), maternal complications (third and fourth-degree perineal tears, failed vaginal instrumental delivery, postpartum hemorrhage, hysterectomy), and neonatal outcomes (Apgar score <5 at 10 minutes, umbilical arterial pH <7.10, neonatal wounds, neonatal intensive care unit admission). A total of 45 women were included in the study. Occiput anterior position was confirmed in 33 women: 16 in the study group and 17 in the control group. Women's characteristics at baseline were similar between the groups. The median (range) angles of progression were similar: 138.4° (15) and 140.3° (16.9) in the study and control group, respectively. Cesarean delivery rates were 12.5% in the study group and 41.1% in the control group (P=.06). Secondary outcomes were similar between the 2 groups. No failed vaginal instrumental delivery was reported. Measurement of the angle of progression in addition to digital examination when fetal head engagement remained uncertain showed promising results in decreasing cesarean delivery rates. A larger multicenter randomized controlled trial is needed to confirm these results.

Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

Background: Failure of descent due to fetal malposition is one of the most common indications for performing surgical deliveries. It has recently been suggested that trans-perineal intra-partum ultrasonography may be useful in assessing fetal head engagement, position and station as well as it’s reliable, cheap, painless and effective tool. Measuring the ‘angle of progression’ could assist in the obstetrician’s decision regarding mode of delivery. Objectives: The primary outcome is to use the AOP to develop a predictive model for the probability of successful vaginal delivery. Secondary outcomes including assessment of possibly successful VBAC in previous one CS women. Methods: We recruited 500 women in labor. For each woman, a (TPU) was performed to measure the AOP in late first and second stages of labor. We compared AOP between women who delivered fetuses through vaginal route to those who delivered by CS. Results: Through 467 women included in the study, AOP was significantly Higher in spontaneous vaginal delivery group (with cut off 123°±8.5°) as compared with women delivered by vacuum or by CS (113°±10.5°) (P=0.003). The VBAC as another secodary outcome seems to be insignificant. Conclusions: TPU is safe, non-invasive and easily preformed technique which is useful to predict labor outcomes.

Fetal head progression and regression on maternal pushing at term and labor outcome.

The aim of our study was two-fold. First, to evaluate the association between the change in the angle of progression (AoP) on maternal pushing and labor outcome. Second, to assess the incidence and clinical significance of the reduction of AoP on maternal pushing. This was a prospective cohort study of nulliparous women with singleton pregnancy at term. AoP was measured at rest and on maximum Valsalva maneuver before the onset of labor, and the difference between AoP on maximum Valsalva and that at rest (ΔAoP) was calculated for each woman. Following delivery and data collection, we assessed the association between ΔAoP and various labor outcomes, including Cesarean section (CS), duration of the first, second and active second stages of labor, Apgar score and admission to the neonatal intensive care unit (NICU). The prevalence of women with reduction of AoP on maximum Valsalva maneuver (AoP-regression group) was calculated and its association with the mode of delivery and duration of different stages of labor was assessed. Overall, 469 women were included in the analysis. Among these, 273 (58.2%) had spontaneous vaginal birth, 65 (13.9%) had instrumental delivery and 131 (27.9%) underwent CS. Women in the CS group were older, had narrower AoP at rest and on maximum Valsalva, higher rate of epidural administration and lower 1-min and 5-min Apgar scores in comparison with the vaginal-delivery group. ΔAoP was comparable between the two groups. On Pearson's correlation analysis, AoP at rest and on maximum Valsalva maneuver had a significant negative correlation with the duration of the first stage of labor. ΔAoP showed a significant negative correlation with the duration of the active second stage of labor (Pearson's r, -0.125; P = 0.02). Cox regression model analysis showed that ΔAoP was associated independently with the duration of the active second stage (hazard ratio, 1.014 (95% CI, 1.003-1.025); P = 0.012) after adjusting for maternal age and body mass index. AoP reduction on maximum Valsalva was found in 73 (15.6%) women. In comparison with women who showed no change or an increase in AoP on maximum Valsalva, the AoP-regression group did not demonstrate significant difference in maternal characteristics, mode of delivery, rate of epidural analgesia, duration of the different stages of labor or rate of NICU admission. In nulliparous women at term before the onset of labor, narrower AoP at rest and on maximum Valsalva, reflecting fetal head engagement, is associated with a higher risk of Cesarean delivery. The increase in AoP from rest to Valsalva, reflecting more efficient maternal pushing, is associated with a shorter active second stage of labor. Fetal head regression on maternal pushing is present in about 16% of women and does not appear to have clinical significance. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Proximate Predictors of Vaginal Delivery in Primigravid women at a Tertiary Health Facility in Ibadan, Nigeria

Background&#x0D; Successful vaginal delivery (VD) is the desire of every parturient. This is however not always so especially for primigravid women. Predictive factors can help the counselling process and allay the anxiety that this group of parturients experience.&#x0D; Objective&#x0D; To determine the prevalence and predictors of vaginal delivery among primigravid women at a tertiary health facility.&#x0D; Methods&#x0D; This was a 6-month cross-sectional study of 200 primigravid women that were planned for vaginal delivery. Information was obtained using structured proforma. Bivariate and multivariable analysis was used to identify the proximate predictors of VD.&#x0D; Results&#x0D; The prevalence of vaginal delivery was 50.0%. Labour onset was spontaneous in 78.0%; 10.0% had engaged fetal head prior to labour onset while labour was augmented in 18.0% of the parturients. Labour lasted ≤12 hours in majority (67.5%) with about half (49.5%) having successful vaginal delivery. Factors predicting successful vaginal delivery were spontaneous labour onset (OR=3.555, 95% CI=1.626-7.774), booked pregnancy (OR=3.008, 95%CI=1.361-6.647), and early fetal head engagement (OR=6.484, 95% CI=1.686-24.943).&#x0D; Conclusion&#x0D; The identified predictive factors of vaginal delivery in this study will aid counselling of primigravid women regarding the likelihood of successful vaginal delivery especially in the absence of other obstetric complications.&#x0D; Rwanda J Med Health Sci 2021;4(1):20-36

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement.

To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean-delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

The Accuracy of Ultrasonography in the Diagnosis of Fetal Head Engagement

There are two paramount queries in the philosophy of labor: when and how to deliver. The answer to these questions is extremely hard. Besides, the pregnant woman is very anxious about her chances of having a vaginal delivery or a cesarean birth..

Is failure of fetal head engagement during previous delivery a contraindication for trial of labor: A French retrospective study

ObjectiveTo study whether history of cesarean delivery for arrest of descent (failure of fetal head engagement or unsuccessful instrumental delivery), is a factor of unsuccessful vaginal birth after cesarean delivery. MethodsMulticenter prospective study of patients undergoing TOL after previous caesarean delivery between May 2012 and May 2013 in 6 maternities. Univariate statistical analysis was performed depending of previous cesarean delivery indication. Multivariate analysis was used to determine independent association between these factors and TOLAC success. ResultsFour hundred and eighty women with previous cesarean delivery were included and separated into two groups: the study group was composed of patients with history of CD for arrest of descent (failure of fetal head engagement or unsuccessful instrumental delivery) (n=31); control group included all other indications for CD (n=449). Overall, of the 480 women included in the study, 71.2 % underwent a TOL for a subsequent delivery (n=342): 68 % in the study group (n=21) vs 71.5 % in the control group (n=321). Vaginal birth after cesarean (VBAC) was obtained in 66.6 % vs 61% in the study and control group respectively (p=0.656). Univariate analysis of factors that may influence the success rate of (VBAC) did not show any difference between the two groups. Multivariate analysis showed that VBAC was only significantly associated with history of vaginal delivery subsequent to prior CD for arrest of descent. ConclusionThis study reassures us in our clinical practice allowing TOL in cases of history of CD for fetal head engagement failure or instrumental delivery failure in the second stage of labor.

EP23.16: Prelabour estimations of delivery mode and fetal head engagement in primiparous at term

EP23.16: Prelabour estimations of delivery mode and fetal head engagement in primiparous at term

Maternal Outcome of among the Primigravida Women Presented with Fetal Head Engagement: Experience of 1440 Cases in Bangladesh

Background: Maternal outcome is an important issue among the primigravida women presented with fetal head engagement.&#x0D; Objectives: The purpose of the present study was to observe the maternal outcome of among the primigravida women presented with fetal head engagement.&#x0D; Methodology: This descriptive cohort study was carried out in the Department of Gynecology and Obstetrics at Sir Salimullah Medical College and Mitford Hospital, Dhaka from June 2006 to December 2006 for a period of sic (6) months. Primaigravida women with 38 or more weeks of pregnancy having single foetus with cephalic presentation were selected as study population. Maternal outcome was measured in terms of incidence of post-partum hemorrhage, injury to the birth canal, wound infection and puerperal sepsis.&#x0D; Result: A total number of 1440 pregnant women were recruited for this study. Maximum number of patients was in the age group of 21 to 24 years which was 897(62.29%). Post partum hemorrhage (PPH) was reported in 7(2.67%) cases in engaged group and 17(1.44%) cases in non-engaged group. Birth canal injury was recorded in 4(1.53%) cases and 12(1.02%) cases in engaged and non-engaged group respectively. Wound infection was found in 8(3.05%) cases and 81(6.88%) cases in engaged and non-engaged group respectively. Regarding puerperal sepsis it was found in 3(1.15%) cases and 11(0.93%) cases in engaged and non-engaged group respectively&#x0D; Conclusion: In conclusion PPH, birth canal injury, wound infection and puerperal sepsis are commonly found in non-engaged group&#x0D; Journal of Science Foundation 2018;16(2):34-37

OC25.02: Fetal head engagement is associated with larger pelvic hiatal dimensions in nulliparous women at term

OC25.02: Fetal head engagement is associated with larger pelvic hiatal dimensions in nulliparous women at term

Assessment of fetal head engagement with transperineal ultrasound: Searching for the cutoff level

PurposeEngagement of the fetal head is a determinant element when deciding on operative vaginal delivery. In routine practice, engagement is a clinical diagnosis based on transvaginal digital examination. Transperineal ultrasound might provide complementary information useful for measuring the fetal head-perineum distance (HPD). The purpose of this work was to determine the cutoff HPD distinguishing engagement from non-engagement. Materials and methodsThis single-center prospective study approved by the institutional review board was conducted between December 25, 2012 and August 31, 2015 in 411 nulliparous women; 20 did not provide informed consent and were excluded; analysis concerned 391 patients. Clinical diagnosis – engagement or non-engagement depending on results of the transvaginal digital examination (Farabeuf's and Demelin's signs) – was compared with the ultrasound HPD measurement. ResultsThe clinical diagnosis was non-engagement at complete dilatation in 96 patients (24.6%). The cutoff HPD distinguishing between engagement and non-engagement was 57mm (AUC 83.5% [95%CI 79.3–87.8]), with 75.0% [65.5–82.6] sensitivity, 75.9% [70.7–80.5] specificity, 50.3% [42.2–58.4] positive predictive value, and 90.3% [86.0-93.4] negative predictive value. ConclusionsIn this series, the HPD cutoff distinguishing between engagement and non-engagement was 57mm. Below this cutoff level, the head should be considered engaged, beyond non-engaged. Nevertheless, the pertinence of this cutoff level is hampered by the imprecision of the gold standard used for the clinical diagnosis (transvaginal digital examination). In case of doubt, we recommend, in addition to considering the obstetrical setting, to combine transperineal ultrasound with transvaginal digital examination to avoid deleterious failure of operative vaginal delivery.

Foetal Outcome of among Women Presented with Fetal Head Engagement: Experience of 1440 Cases in Bangladesh

Background: Foetal outcome is a great concern among the primigravida women presented with fetal head engagement.Objectives: The purpose of the present study was to see foetal outcome among the women presented with fetal head engagement.Methodology: This descriptive cohort study was carried out in the Department of Gynecology and Obstetrics at Sir Salimullah Medical College and Mitford Hospital, Dhaka from June 2006 to December 2006 for a period of sic (6) months. Primaigravida women with 38 or more weeks of pregnancy having single foetus with cephalic presentation were selected as study population. Foetal outcome was measured in terms of APGAR score.Result: A total number of 1440 pregnant women were recruited for this study. In this study the APGAR score of all the babies were good. APGAR score were low in l2 cases and returned to normal alter resuscitation. Out of 262 engaged cases 7 to 10 APGAR score was found in 261(99.6%) cases. In 1178 unengaged cases 7 to 10 APGAR score was found in 1167(99.1%) cases. APGAR score 4 to 6 was found in 1 case and 11 cases in engaged and unengaged group. However, 0 to 3 APGAR score was not reported in engaged and unengaged group. There was no statistical significant between the engaged and unengaged group considering the APGAR score of 7 to 10 and 4 to 6 (p=0.374).Conclusion: In conclusion fetal outcome is not significantly different between the engaged and unengaged pregnant women during considering the APGAR score.Journal of Current and Advance Medical Research 2018;5(1):29-32

Sonographic parameters for diagnosing fetal head engagement during labour.

The purpose of this study was to investigate the diagnostic performance of the head-perineum distance, angle of progression, and the head-symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head-perineum distance, angle of progression, and head-symphysis distance for values correlating with digital vaginal examination head station. Using station 0 as the minimum level of head engagement, correlating cut-off values for head-perineum distance, angle of progression, and head-symphysis distance were obtained. Receiver operating characteristics were used in determining the diagnostic performance of these cut-off values for the detection of fetal head engagement. With head-perineum distance of 3.6 cm the sensitivity and specificity of sonographic determination of engaged fetal head were 78.7 and 72.3%, respectively. A head-symphysis distance of 2.8 cm also had sensitivity and specificity of 74.5 and 70.8%, respectively, in determining engagement, whilst an angle of progression of 101° was consistent with engagement by digital vaginal examination with 68.1% sensitivity and 68.2% specificity. Ultrasound shows high diagnostic performance in determining engaged fetal head at a head-perineum distance of ≤3.6 cm, head-symphysis distance of ≤2.8 cm, and angle of progression of ≥ 101°.

OP26.01: Transperineal evaluation of fetal head engagement in primiparous at term

OP26.01: Transperineal evaluation of fetal head engagement in primiparous at term