dc.contributor |
Háskóli Íslands |
dc.contributor |
University of Iceland |
dc.contributor.author |
Hjartardóttir, Hulda |
dc.contributor.author |
Lund, Sigrún Helga |
dc.contributor.author |
Benediktsdottir, Sigurlaug |
dc.contributor.author |
Geirsson, Reynir |
dc.contributor.author |
Eggebø, Torbjørn M. |
dc.date.accessioned |
2021-05-25T11:28:41Z |
dc.date.available |
2021-05-25T11:28:41Z |
dc.date.issued |
2021-04 |
dc.identifier.citation |
Dr Hulda Hjartardottir MD , Ms Sigr ´ un H. Lund PhD , ´ Dr Sigurlaug Benediktsdottir MD , Dr Reynir T. GEIRSSON MD, PhD , Dr Torbjørn M. Eggebø MD, PhD , ´ Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery?, American Journal of Obstetrics & Gynecology MFM (2021), doi: https://doi.org/10.1016/j.ajogmf.2021.100383 |
dc.identifier.issn |
2589-9333 |
dc.identifier.uri |
https://hdl.handle.net/20.500.11815/2589 |
dc.description.abstract |
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 angle of progression ≥93° the
median duration was 506 minutes compared to 732 min when <93° (log rank test,
p=0.008, adjusted HR for AoP was 2.07; 95% CI: 1.15 to 3.72). The median time to
delivery for non-occiput posterior positions was 506 minutes compared with 677 minutes
for occiput posterior positions (log rank test, p=0.07, adjusted HR 1.52; 95% CI: 0.96-
2.38) Median time to delivery was 429 minutes for dilatation of ≥6 cm and 704 minutes
for dilatation of 4-5 cm (log rank test, p=0.002, adjusted HR 3.11; 95% CI: 1.68 to 5.77).
Spontaneous deliveries were 75, 16 were instrumental vaginal (one forceps and 15
ventouse) and eight were cesarean deliveries. Head-perineum distance was associated
with spontaneous delivery with AUC=0.68 (95% CI; 0.55 to 0.80) and angle of
progression with AUC=0.67 (95% CI; 0.55 to 0.80). Ultrasound measurement of cervical
dilatation or position at inclusion were not significantly associated with a spontaneous
delivery.
Conclusions
Ultrasound examinations showed that fetal head station and cervical dilatation was
associated with the duration of labor but measurements of fetal head station were the
variables best associated with operative deliveries. |
dc.description.sponsorship |
Icelandic Centre for Research |
dc.format.extent |
100383 |
dc.language.iso |
en |
dc.publisher |
Elsevier BV |
dc.relation.ispartofseries |
American Journal of Obstetrics & Gynecology MFM; |
dc.rights |
info:eu-repo/semantics/embargoedAccess |
dc.subject |
Fósturfræði |
dc.subject |
Fæðing |
dc.title |
Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery? |
dc.type |
info:eu-repo/semantics/article |
dc.identifier.journal |
American Journal of Obstetrics & Gynecology MFM |
dc.identifier.doi |
https://doi.org/10.1016/j.ajogmf.2021.100383 |
dc.contributor.department |
Læknadeild (HÍ) |
dc.contributor.department |
Faculty of Medicine (UI) |
dc.contributor.school |
Heilbrigðisvísindasvið (HÍ) |
dc.contributor.school |
School of Health Sciences (UI) |