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Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery?

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dc.contributor Landspitali - The National University Hospital of Iceland
dc.contributor.author Hjartardóttir, Hulda
dc.contributor.author Lund, Sigrún Helga
dc.contributor.author Benediktsdóttir, Sigurlaug
dc.contributor.author Geirsson, Reynir T
dc.contributor.author Eggebø, Torbjørn M.
dc.date.accessioned 2022-11-15T01:03:50Z
dc.date.available 2022-11-15T01:03:50Z
dc.date.issued 2021-04-23
dc.identifier.citation Hjartardóttir , H , Lund , S H , Benediktsdóttir , S , Geirsson , R T & Eggebø , T M 2021 , ' Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery? ' , American journal of obstetrics & gynecology MFM , vol. 3 , no. 5 , pp. 100383 . https://doi.org/10.1016/j.ajogmf.2021.100383
dc.identifier.issn 2589-9333
dc.identifier.other PURE: 44983213
dc.identifier.other PURE UUID: eb595456-b0c2-4b1b-88a6-9dcfe342ddbb
dc.identifier.other researchoutputwizard: hdl.handle.net/20.500.11815/2589
dc.identifier.other researchoutputwizard: hdl.handle.net/2336/622006
dc.identifier.uri https://hdl.handle.net/20.500.11815/3605
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 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 outcomes. Objective: This study aimed to investigate whether 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, Reykjavík, Iceland. Nulliparous women at ≥37 weeks' gestation with a single fetus in cephalic presentation and in active spontaneous labor were eligible for the study. The recruitment period was from January 2016 to April 2018. Women were examined by a midwife on admission and included in the study if they were in active labor, which was defined as regular contractions with a fully effaced cervix, dilatation of ≥4 cm. 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 examinations 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 body mass index. The associations between study parameters and mode of delivery were evaluated using receiver operating characteristic curves. Results: Median times to spontaneous delivery were 490 minutes for a head-perineum distance of ≤45 mm and 682 minutes for a head-perineum distance of >45 mm (log-rank test, P=.009; adjusted hazard ratio for a shorter head-perineum distance, 1.47 [95% confidence interval, 0.83-2.60]). The median durations were 506 minutes for an angle of progression of ≥93° and 732 minutes for an angle of progression of <93° (log-rank test, P=.008; adjusted hazard ratio, 2.07 [95% confidence interval, 1.15-3.72]). The median times to delivery were 506 minutes for nonocciput posterior positions and 677 minutes for occiput posterior positions (log-rank test, P=.07; adjusted hazard ratio, 1.52 [95% confidence interval, 0.96-2.38]) Median times to delivery were 429 minutes for a dilatation of ≥6 cm and 704 minutes for a dilatation of 4 to 5 cm (log-rank test, P=.002; adjusted hazard ratio, 3.11 [95% confidence interval, 1.68-5.77]). Overall, there were 75 spontaneous deliveries; among those deliveries, 16 were instrumental vaginal deliveries (1 forceps delivery and 15 ventouse deliveries), and 8 were cesarean deliveries. Head-perineum distance and angle of progression were associated with a spontaneous delivery with area under the receiver operating characteristic curves of 0.68 (95% confidence interval, 0.55-0.80) and 0.67 (95% confidence interval, 0.55-0.80), respectively. Ultrasound measurement of cervical dilatation or position at inclusion was not significantly associated with spontaneous delivery. Conclusion: Ultrasound examinations showed that fetal head station and cervical dilatation were associated with the duration of labor; however, measurements of fetal head station were the variables best associated with operative deliveries. Keywords: angle of progression; delivery time; fetal head station; head-perineum distance; labor; transperineal ultrasound.
dc.format.extent 100383
dc.format.extent 100383
dc.language.iso en
dc.relation.ispartofseries American journal of obstetrics & gynecology MFM; 3(5)
dc.rights info:eu-repo/semantics/openAccess
dc.subject Fæðinga- og kvensjúkdómafræði
dc.subject angle of progression
dc.subject delivery time
dc.subject fetal head station
dc.subject head-perineum distance
dc.subject labor
dc.subject transperineal ultrasound
dc.subject Ómskoðun
dc.subject Fæðing
dc.subject Ultrasonography, Prenatal
dc.subject Labor Presentation
dc.subject angle of progression
dc.subject delivery time
dc.subject fetal head station
dc.subject head-perineum distance
dc.subject labor
dc.subject transperineal ultrasound
dc.subject Ómskoðun
dc.subject Fæðing
dc.subject Ultrasonography, Prenatal
dc.subject Labor Presentation
dc.title Can ultrasound on admission in active labor predict labor duration and a spontaneous delivery?
dc.type /dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article
dc.description.version Peer reviewed
dc.identifier.pmid 33901721
dc.identifier.doi https://doi.org/10.1016/j.ajogmf.2021.100383
dc.relation.url https://www.sciencedirect.com/science/article/pii/S2589933321000781?via%3Dihub
dc.contributor.department Women's and Childrens's Services
dc.contributor.department Faculty of Physical Sciences


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