Failed Labor
Conditions
Keywords
prolonged labor, cesarean section, duration of labor
Brief summary
Objectives 1. To assess if head-perineum distance and angle of progression measured with transperineal ultrasound by the obstetrician on call can predict delivery mode in primiparous women with prolonged first stage of labour. 2. To compare ultrasound assessments and clinical examinations.
Detailed description
Variables Digitally assessed cervical dilatation, fetal station and position Ultrasound measured fetal head-perineum distance. Ultrasound measured angle of progression Ultrasound assessed position Possible confounders Ethnicity, maternal age, gestational age, BMI, induction of labour, augmentation, epidural analgesia, birth weight, head circumference A two-dimensional ultrasound measurement will be obtained with the ultrasound device available in the delivery department. Fetal head descent is measured as the shortest distance between the outer bony limit of the fetal skull and the perineum with a curved transabdominal transducer placed transperineally between the labia in a transverse view (1). The fetal descent will also be assessed measuring angle of progression as suggested by Barbera et al. The ultrasound transducer will be placed on the perineum in a mid-sagittal position between the labia below the pubic symphysis. The angle between a line through the symphysis and a line from the posterior part of the symphysis tangentially to the fetal skull contour will be measured (2) A transabdominal scan will also be performed determining the fetal position as described previously. Positions ≥ 02.30 and ≤ 03.30 hours should be recorded as left occiput transverse and positions ≥ 08.30 and ≤ 09.30 as right occiput transverse. Positions \> 03.30 and \<08.30 should be recorded as occiput posterior and positions \> 09.30 and \< 02.30 as occiput anterior.(3).
Interventions
PROCEDUREultrasound examination
transabdominal and transperineal ultrasound examinations
Sponsors
Norwegian University of Science and Technology
Haukeland University Hospital
Skane University Hospital
Hvidovre University Hospital
Cambridge University Hospitals NHS Foundation Trust
Helse Stavanger HF
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
15 Years to 48 Years
Healthy volunteers
Yes
Inclusion criteria
* Primiparous women with single pregnancies and gestation age \> 37 weeks and prolonged first stage of labor
Exclusion criteria
* High risk pregnancies, * premature deliveries, * multiple pregnancies
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Women With Vaginal Deliveries | active labor | Women were categorized in accordance to fetal descent measured by ultrasound. Head-perineum distance (HPD) ≤40 mm and angle of progression (AoP) ≥110 degrees were used as cut-off level. HPD was obtained in all 150 cases and AoP was successfully obtained in 145 cases. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Women With Cesarean Section | active labor | The percentage of women with cesarean section was compared in cases with occiput posterior position and cases with non occiput posterior position assessed with transabdominal sonography when prolonged labor was diagnosed. |
Countries
Denmark, Norway, Sweden, United Kingdom
Participant flow
Recruitment details
Recruitment was from 1. January 2012 until 30. April 2013
Participants by arm
| Arm | Count |
|---|---|
| Transperineal Ultrasound Fetal head descent was assessed using a transperineal scan | 150 |
| Total | 150 |
Baseline characteristics
| Characteristic | Transperineal Ultrasound |
|---|---|
| Age, Continuous | 29 years |
| Region of Enrollment Norway | 87 participants |
| Region of Enrollment United Kingdom | 63 participants |
| Sex: Female, Male Female | 150 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 150 |
| serious Total, serious adverse events | 0 / 150 |
Outcome results
Primary
Percentage of Women With Vaginal Deliveries
Women were categorized in accordance to fetal descent measured by ultrasound. Head-perineum distance (HPD) ≤40 mm and angle of progression (AoP) ≥110 degrees were used as cut-off level. HPD was obtained in all 150 cases and AoP was successfully obtained in 145 cases.
Time frame: active labor
Population: AoP could not be measured in 5 cases because only a part of the symphysis was visualized.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Transperineal Ultrasound | Percentage of Women With Vaginal Deliveries | Vaginal deliveries if HPD was ≤40 mm (n=84) | 92 percentage of participants in each group |
| Transperineal Ultrasound | Percentage of Women With Vaginal Deliveries | Vaginal deliveries if HPD was >40 mm (n=66) | 52 percentage of participants in each group |
| Transperineal Ultrasound | Percentage of Women With Vaginal Deliveries | Vaginal deliveries if AoP was ≥110 degrees (n=84) | 88 percentage of participants in each group |
| Transperineal Ultrasound | Percentage of Women With Vaginal Deliveries | Vaginal deliveries if AoP was <110 degrees (n=61) | 57 percentage of participants in each group |
Comparison: Women were categorized in accordance to fetal descent measured by ultrasound. Head-perineum distance ≤40 mm was used as cut-off level. Vaginal delivery was the primary outcome measure.p-value: <0.01Chi-squared
Secondary
Percentage of Women With Cesarean Section
The percentage of women with cesarean section was compared in cases with occiput posterior position and cases with non occiput posterior position assessed with transabdominal sonography when prolonged labor was diagnosed.
Time frame: active labor
Population: Fetal head position was assessed successfully using transabdominal ultrasound in 142/150 women. Position could not be diagnosed in eight cases due to shadowing from maternal pelvis in cases at low stations.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Transperineal Ultrasound | Percentage of Women With Cesarean Section | Cesarean section in cases with OP position (n=50) | 38 percentage of participants in each group |
| Transperineal Ultrasound | Percentage of Women With Cesarean Section | Cesarean sin cases with non-OP position (n=92) | 17 percentage of participants in each group |
p-value: 0.01Chi-squared