Gamal Omar Ghany
Cairo University, EgyptPresentation Title:
The value of intrapartum ultrasound in predicting mode of delivery: A prospective cohort study
Abstract
Objective: The main aim of this study was to explore the value of several intrapartum ultrasonographic parameters in predicting mode of birth following spontaneous labor.
Methods: This prospective observational cohort study included two groups of primparous term singleton vertex presentation pregnant patients >18 years old admitted in the first stage of labor between January 2021 and May 2023: a cesarean section (CS) group and a normal vaginal delivery (NVD) group. All patients provided informed written consent. The investigation utilized both transabdominal and transperineal ultrasonography for comprehensive fetal and pelvic floor assessment. Transabdominal ultrasound evaluated standard parameters including fetal occiput position, biometry number, viability, presentation, and estimated fetal weight. Intrapartum transperineal ultrasonography, specifically performed during the first stage of labor, focused on the Levator Hiatus, measuring its anteroposterior diameter (APD) at rest and during Valsalva maneuver, as well as
the angle of progression (AOP).
Results: The study population comprised 609 participants with a mean age of 22.8 ± 4.3 years and a high prevalence of being overweight and obesity (38.8% and 57.8%, respectively). When comparing patients who had an intrapartum CS to those who had a normal vaginal delivery (NVD). However, on logistic regression, age, BMI, gestational age, posterior occiput presentation, head circumference (HC), AOP (V) and APD (V) as significant predictors for both ICS and 2nd stage CS (p<0.05).
Conclusion: This study demonstrated that maternal age, BMI, gestational age, occiput posterior position, Angle of progression at Valsalva and levator hiatus anteroposterior diameter at Valsalva were independent significant predictors for Intrapartum cesarean section in primiparous women at term When the ratio between HC/APD at rest, BPD/APD at Valsalva and HC/APD at Valsalva is high, while the APD at Valsalva, AoP Valsalva values are low, cesarean section was more likely to be the mode
of delivery.
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