The Role of Ultrasonography in Labor in Predicting the Outcomes of Childbirth

Condition(s) studied

Study summary

Ultrasound in the delivery room represents a useful diagnostic tool and is used for the assessment of fetal presentation, fetal malpresentation/malposition, and prior to any operative delivery. Transperineal ultrasonography, performed by placing the ultrasound probe covered by a sterile glove at the level of the labia majora, has proven useful in providing information on the progression of the presented fetal part in the birth canal and in predicting birth outcomes. Many studies have shown a correlation between the above ultrasound indices and birth outcomes. These ultrasound indices are therefore used in clinical practice to assess the progression of the presented fetal part in the birth canal and the presence of fetal malpresentation/malposition. Despite this, to date, few studies have evaluated the correlation between dynamic changes in these ultrasound parameters between rest and maximal maternal pushing during the second stage of labor and birth outcomes.

Knowing before delivery which parameters are suggestive of possible dystocia would allow the clinician to adopt therapeutic strategies aimed at resolving them and thus increase the rate of spontaneous vaginal deliveries.

The investigators want to evaluate the role of an ultrasound parameter obtained by transabdominal ultrasound in the second stage of labor, the occiput-column angle, in predicting spontaneous delivery vaginally in fetuses with transverse occiput

Eligibility

Primary outcome measure(s)

• Measurement of Angle of Progression (AoP) — At the time of delivery: at rest and during maternal pushing
  Angle of progression (AoP): the angle between the longitudinal axis of the pubic symphysis and a straight line starting from the lower edge of the symphysis and passing tangentially to the most distal part of the fetal head
• Measurement of Anteroposterior Pelvic Hiatus Diameter (APD) — At the time of delivery: at rest and during maternal pushing
  Anteroposterior pelvic hiatus diameter (APD): distance between the posteroinferior margin of the pubic symphysis and the anterior margin of the pubo-rectal muscle
• Measurement of Head-Sympanic Distance (HSD) — At the time of delivery: at rest and during maternal pushing
  Head-symphysis distance (HSD): distance between the lower edge of the pubic symphysis and the nearest point of the fetal scalp along the infrapubic line
• Measurement of Head-Perineum Distance (HPD) — At the time of delivery: at rest and during maternal pushing
  Head-Perineum Distance (HPD): distance between the perineum and the nearest point of the fetal scalp

Trial sites (1)

More IRCCS Azienda Ospedaliero-Universitaria di Bologna trials in Italy