Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery?
Background Identifying predictive factors for a normal outcome at admission in the labor ward would be of value for planning labor care, timing interventions and in preventing labor dystocia. Clinical assessments of fetal head station and position at the start of labor have some predictive value but...
| Published in: | American Journal of Obstetrics & Gynecology MFM |
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| Main Authors: | , , , , |
| Other Authors: | , , , , , |
| Format: | Article in Journal/Newspaper |
| Language: | English |
| Published: |
Elsevier BV
2021
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| Subjects: | |
| Online Access: | https://hdl.handle.net/20.500.11815/2589 https://doi.org/10.1016/j.ajogmf.2021.100383 |
| Summary: | Background Identifying predictive factors for a normal outcome at admission in the labor ward would be of value for planning labor care, timing interventions and in preventing labor dystocia. Clinical assessments of fetal head station and position at the start of labor have some predictive value but the value of ultrasound methods for this purpose has not been investigated. Studies using transperineal ultrasound before labor onset show possibilities of using these methods to predict outcome. Objective To investigate if ultrasound measurements during the first examination in the active phase of labor were associated with the duration of labor phases and the need for operative delivery. Study Design This was a secondary analysis of a prospective cohort study at Landspitali University Hospital, Reykjavik, Iceland. Nulliparous women at ≥37 weeks with a single fetus in cephalic presentation and spontaneous labor onset were eligible. The recruitment period was from January 2016 to April 2018. Women were examined by a midwife on admission and included if in established active phase defined as regular contractions with a fully effaced cervix, open four cm or more. An ultrasound examination was performed by a separate examiner within 15 minutes, both examiners were blinded to the other's results. Transabdominal and transperineal ultrasound were used to assess fetal head position, cervical dilatation and fetal head station expressed as head-perineum distance and angle of progression. Duration of labor was estimated as the hazard ratio for spontaneous delivery using Kaplan-Meier curves and Cox regression analysis. The hazard ratios were adjusted for maternal age and BMI. The associations between study parameters and mode of delivery were evaluated using receiver-operating characteristic curves. Results Median time to spontaneous delivery when head-perineum distance was ≤45 mm was 490 minutes compared to 682 min when >45mm (log rank test, p=0.009, but the adjusted HR for shorter HPD was 1.47; 95% CI; 0.83 to 2.60). For ... |
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