Journal Article•
Intrapartum ultrasonogram for the determination of fetal occiput position and risk of cesarean section.
01 Feb 2010-Journal of the Medical Association of Thailand Chotmaihet thangphaet (J Med Assoc Thai)-Vol. 93, Iss: 2, pp 149-153
TL;DR: Fetal occiput posterior presentation determined in early stage of active labor by ultrasonography was a significant independent risk of cesarean section.
Abstract: Results: The incidence of occiput posterior was 29.7%. The abnormal cervical dilatation, cesarean delivery, and newborn weight were statistically significantly higher in cases. 44.9% of cases underwent cesarean section compared to 14.7% of controls. Conclusion: Fetal occiput posterior presentation determined in early stage of active labor by ultrasonography was a significant independent risk of cesarean section.
Citations
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TL;DR: An ultrasound approach, transabdominal, transperineal and transvaginal, has clearly shown its superior diagnostic accuracy for diagnosis of malpositions, detected in both first and second stage of labor, but also in cases of marked asynclitism.
Abstract: The occiput posterior (OP) position is one of the most frequent malposition during labor. During the first stage of labor, the fetal head may stay in the OP position in 30% of the cases, but of these only 5-7% remains as such at time of delivery. The diagnosis of OP position in the second stage of labor is made difficult by the presence of the caput succedaneum or scalp hair, both of which may give some problem in the identification of fetal head sutures and fontanels and their location in relationship to maternal pelvic landmarks. The capability of diagnosing a fetus in OP position by digital examination has been extremely inaccurate, whereas an ultrasound approach, transabdominal, transperineal and transvaginal, has clearly shown its superior diagnostic accuracy. This is true not only for diagnosis of malpositions, detected in both first and second stage of labor, but also in cases of marked asynclitism.
56 citations
Cites background from "Intrapartum ultrasonogram for the d..."
...[27] evaluated the value of intrapartum ultrasonographically determined occiput position and risk of cesarean section in 330 singleton term pregnant women with fetuses in cephalic presentation who were in early active phase of labor....
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TL;DR: A systematic review was performed to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery.
Abstract: Objective We performed a systematic review to determine whether sonographic assessment of occipital position of the fetal head can contribute to the prediction of the mode of delivery. Methods We performed a systematic literature search of electronic databases from inception to May 2011. Two reviewers independently extracted data from the included studies. We used a bivariate model to estimate point estimates for sensitivity and specificity curves for the outcome Cesarean delivery. Eligible studies were cohort studies or cross-sectional studies that reported on both the position of the fetal head, as assessed by ultrasound, before or at the beginning of active labor as well as the outcome of labor in women at term. Results We included 11 primary articles reporting on 5053 women, of whom 898 had a Cesarean section. All studies indicated disappointing values for sensitivity and specificity in the prediction of Cesarean section. Summary point estimates of sensitivity and specificity were 0.39 (95% CI, 0.32–0.48) and 0.71 (95% CI, 0.67–0.74), respectively. Conclusion Sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery. Copyright 2012 ISUOG. Published by John Wiley & Sons, Ltd.
35 citations
TL;DR: The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate and is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.
Abstract: Background Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. Methods This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. Results In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). Discussion The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women.
21 citations
TL;DR: Intrapartum sonographic assessment of fetal descent is promising in that it potentially offers a more objective assessment compared with digital vaginal assessment and, when severe, is an additional etiology of cephalopelvic disproportion.
Abstract: Given the irregular shape of the maternal pelvis and the relatively large dimensions of the fetal head at term, accommodation or adaptation of portions of the fetal head to various maternal pelvic planes is required for successful vaginal birth. Positional changes in the presenting part that are necessary to enable the fetus to navigate the pelvic canal are incorporated in the cardinal movements of labor and include: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion1,2. During labor, these movements, although sequential, often exhibit considerable temporal overlap. For example, engagement is associated with concurrent flexion and descent of the fetal head. Additional adaptive measures include intrapartum moulding of the fetal head: changes in the fetal head shape due to external compressive forces, resulting in a shortened suboccipitobregmatic diameter and a lengthened mentovertical diameter1,2. Fetal descent in particular is essential for successful (non-operative) vaginal birth and hence serves as a major component in the clinical assessment of progress of labor. Lack of descent is often a result of malrotation of the fetal head, resulting in relative cephalopelvic disproportion. Fetal descent is evaluated clinically by digital vaginal assessment in relation to the maternal ischial spines in a highly subjective and frequently inaccurate manner1–3 and is often further compromised by the presence of moulding of the fetal head1,2. Ultrasound assessment of labor has been applied increasingly during recent years. Clinical parameters/cardinal movements of labor amenable to intrapartum sonographic assessment include fetal head position4–15, engagement16,17, descent and internal rotation18–25. Transperineal/translabial ultrasound has been utilized to enhance depiction of descent and internal rotation of the fetal head, and determine the following parameters: head direction, angle of the middle line, progression distance, head–perineum distance and angle of progression18–36. Intrapartum sonographic assessment of fetal descent is promising in that it potentially offers a more objective assessment compared with digital vaginal assessment3. Although clinical application remains to be determined, recently, Bamberg et al. reported real-time open magnetic resonance imaging, in the mid-sagittal plane, of extension of the fetal head in the late second stage of labor37. Of note, sonography may also depict moulding of the fetal head1,38. In addition, intrapartum sonographic findings of asynclitism (lateral deflection of the sagittal suture), which, when severe, is an additional etiology of cephalopelvic disproportion, have been reported recently1,2,39,40.
10 citations
Dissertation•
07 Jun 2017
TL;DR: In this paper, the authors evaluate the eficacia of the use of the posicion of Sims modificada postural materna sobre el lado del dorso fetal, respecto a posiciones libres maternas, for the rotacion of the variedad fetal occipitoposterior persistente a occipitoanterior durante el trabajo de parto, in mujeres with analgesia peridural.
Abstract: Introduccion: El parto normal se define como el conjunto de fenomenos que conducen a la expulsion del feto y de los anejos ovulares. La posicion optima de la cabeza fetal para el parto es la que situa la parte posterior (occipucio) dirigida hacia la parte anterior de la pelvis materna, posicion occipitoanterior. Cuando el occipucio de la cabeza fetal se situa hacia la parte posterior de la pelvis materna, posicion occipitoposterior, se asocia a un trabajo de parto mas doloroso, prolongado y a un aumento de la morbilidad tanto materna como fetal. Objetivo general: Evaluar la eficacia del uso de la posicion de Sims modificada materna sobre el lado del dorso fetal, respecto a posiciones libres maternas, para la rotacion de la variedad fetal occipitoposterior persistente a occipitoanterior durante el trabajo de parto, en mujeres con analgesia peridural. Metodologia: Se trata de un ensayo clinico, controlado, aleatorio y abierto. El estudio se realizo en el Hospital Universitari Vall d’Hebron. Se seleccionaron 120 gestantes con fetos en posiciones occipitoposteriores persistentes. El diagnostico se realizaba mediante tacto vaginal. Las mujeres se aleatorizaban a cada uno de los grupos, mediante secuencia generada por un programa informatico al grupo control o al grupo experimental. Las mujeres del grupo control realizaron el trabajo de parto en posiciones libres (cuidados habituales) y las gestantes del grupo intervencion realizaron el trabajo de parto en posicion de Sims modificada del mismo lado que la variedad fetal, posicionando la pierna libre sobre la pernera, realizando una rotacion interna de la rodilla. Resultados: La variable principal de resultado fue la correccion de la variedad fetal y la variable secundaria el tipo de parto. Las mujeres que realizaron el trabajo de parto en posicion de Sims, los fetos en posiciones posteriores rotaron a posiciones anteriores en un 55.1% de los casos mientras que en el grupo de posiciones libres, la rotacion ocurrio con una frecuencia de 21.82% siendo estos resultados estadisticamente significativos (p=0.0016). Al valorar el tipo de parto, se encontro que en el grupo de posicion de Sims, los partos eutocicos significaron el 61.22% mientras que en el grupo de posiciones libres ocurrieron en un 49,04%. Si observamos el numero de partos por cesareas, en el grupo de Sims estos suceden en un 10,2% de los casos, mientras que en el grupo de posiciones libres, ocurrio en el 21.15% de los casos siendo estos resultados estadisticamente significativos (p=0.0456) Conclusiones: La posicion de Sims es una intervencion postural materna efectiva en la rotacion de posiciones fetales posteriores persistentes, disminuyendo de este modo los partos por cesarea y aumentando los partos eutocicos, siendo una intervencion sencilla, reproducible y bien tolerada por la mujer.
5 citations
References
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TL;DR: Persistent occiput posterior position is associated with a higher rate of complications during labor and delivery, and in this population, the chances that a laboring woman with persistent occipUT posterior position will have a spontaneous vaginal delivery are only 26% for nulliparas and 57% for multiparas.
247 citations
TL;DR: Persistent occiput posterior position led to a sevenfold increase in the incidence of anal sphincter injury, and was associated with significantly higher incidences of prolonged pregnancy, induction of Labor, oxytocin augmentation of labor, epidural use, and prolonged labor.
242 citations
TL;DR: Using ultrasound assessment as the gold standard, transvaginal digital determination of fetal head position during active labor demonstrates an overall high rate of error (76%) and may serve as an educational tool for physicians in training.
Abstract: Objective
To test the null hypothesis that no correlation exists between transvaginal digital and the gold standard technique of transabdominal suprapubic ultrasound assessments of fetal head position during labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound, respectively.
Methods
Consecutive patients in active labor at term with normal singleton cephalic-presenting fetuses were included. All participants had ruptured membranes, cervical dilation ≥4 cm and fetal head at ischial spine station –2 or lower. Transvaginal sterile digital examinations were performed by either senior residents or attending physicians and followed immediately by transverse suprapubic transabdominal ultrasound assessments. Examiners were blinded to each other's findings. Power-analyses dictated number of subjects required. Statistical analyses included Chi-square, Cohen's Kappa test and logistic regression analysis. P < 0.05 was considered statistically significant.
Results
One hundred and two patients were studied (n = 102). In only 24% of patients (n = 24), transvaginal digital examinations were consistent with ultrasound assessments (P = 0.002, 95% confidence interval, 16–33). Logistic regression revealed that cervical effacement (P = 0.03) and ischial spine station (P = 0.01) significantly affected the accuracy of transvaginal digital examination. Parity, gestational age, combined spinal epidural anesthesia, cervical dilation, birth weight and examiner experience did not significantly affect accuracy of the examination. The accuracy of the transvaginal digital exams was increased to 47% (n = 48) (95% confidence interval, 37–57) when fetal head position at transvaginal digital examination was recorded as correct if reported within ±45° of the ultrasound assessment. The rate of agreement between the two assessment methods for attending physicians vs. residents was 58% vs. 33%, respectively (P = 0.02) with the ±45° analysis.
Conclusions
Using ultrasound assessment as the gold standard, our data demonstrate an overall high rate of error (76%) in transvaginal digital determination of fetal head position during active labor, consistent with the null hypothesis. Attending physicians exhibited an almost two-fold higher success rate in depicting correct fetal head position by physical examination vs. residents in the ±45° analysis. Intrapartum ultrasound increases the accuracy of fetal head position assessment during active labor and may serve as an educational tool for physicians in training. Copyright © 2002 ISUOG
240 citations
TL;DR: Routine digital examination during labor fails to identify the correct fetal position in the majority of cases, and the rate of correct identification by digital examination increased with cervical dilatation.
Abstract: Objective: To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head. Patients and methods: In 496 singleton pregnancies in labor at term, the fetal head position was determined by routine transvaginal digital examination by the attending midwife or obstetrician. Immediately before or after the clinical examination, the fetal head position was determined using transabdominal ultrasound by an appropriately trained sonographer who was not aware of the clinical findings. The digital examination was considered to be correct if the fetal head position was within 45° of the ultrasound finding. The accuracy of the digital examination was examined in relation to maternal characteristics and the progress of labor. Results: The position of the fetal head was determined by ultrasound examination in all 496 cases examined. Digital examination failed to define the fetal head position in 166 (33.5%) cases and, in 330 cases where the position was determined, t...
193 citations
TL;DR: Intrapartum sonography proved to be useful in investigating the development of the persistent occipitoposterior position and higher maternal BMI correlates with higher fetal weight, increased operative deliveries, lower Apgar scores at 1 minute, and posterior placental locations.
149 citations