Can Ultrasound Performed in Prolonged Second Stage of Labor Predict the Difficulty and Success Rates of Operative Vaginal Delivery?

Abstract

Objective: To evaluate different sonographic methods for the prediction of the difficulty and the success of operative vaginal delivery (OPD).

Materials and Methods: A prospective study was performed on 45 term singleton uncomplicated pregnancies with prolonged 2nd stage of delivery with cephalic presentation. Measurements of the fetal head, relations between the fetal head and maternal pelvic parameters during rest and during maternal pushing were taken using translabial ultrasound.

Results: 29 cases of OPD were successful and 4 cases failed ending in cesarean section. The passage of the biparietal diameter (BPD) of the infrapubic line (IPL) was statistically correlated with the success of OPD. Head station, passage of the BPD of the IPL, percentage of head after the IPL, circumference of head after IPL were all correlated with the difficulty of OPD. When the distance between the widest diameter of the head and the IPL is < 1.2 cm, there is a 90 % probability of success of OPD. When that distance is > 3.3 cm, there is 90 % probability of cesarean section. When the percentage of head beyond the IPL was > 54 %, there was 90 % probability of successful OPD.

Discussion: Translabial ultrasound is useful in the prediction of the difficulty and the success of OPD. The higher the extent of head that passed the IPL, the less difficult the OPD and the greater the success rate of the OPD.

Zusammenfassung

Ziel: Bewertung verschiedener sonografischen Methoden zur Vorhersage von Schwierigkeiten und Erfolg der vaginal-operative Entbindung (OPD).

Material und Methoden: Eine prospektive Studie wurde bei 45 voll ausgetragenen, komplikationslosen Einlingsschwangerschaften durchgeführt, die sich in der protrahierten Austreibungsperiode mit Eintritt des Kopfes befanden. Die Messungen des fetalen Kopfes und die Verhältnisse der Parameter von fetalem Kopf und mütterlichem Becken wurden während der Wehenpause und der mütterlichen Pressphase durch translabiale Sonografie ermittelt.

Ergebnisse: Die OPD war bei 29 Fällen erfolgreich und bei 4 Fällen erfolglos und endete mit Kaiserschnitt. Die Passage des biparietalen Durchmessers (BPD) durch die infrapubische Linie (IPL) zeigte eine statistisch-signifikante Korrelation zum Erfolg der OPD. Die Kopfhöhe, die Passage des BPD durch die IPL und der der prozentuale Anteil des Kopfes nach der IPL, der Kopfumfang nach der IPL korrelierten allesamt mit Schwierigkeiten bei der OPD. Wenn der Abstand zwischen dem größten Kopfdurchmesser und der IPL < 1,2 cm betrug, war der Wahrscheinlichkeit für das Gelingen der OPD 90 %. Bei einem Abstand von > 3,3 cm betrug die Wahrscheinlichkeit einer Schnittentbindung 90 %. Wenn der Anteil des Kopfes nach der IPL > 54 % war so hatte die OPD eine 90 % Erfolgsmöglichkeit.

Schlussfolgerung: Der translabiale Ultraschall unterstützt die Vorhersage von Schwierigkeiten und Erfolg der OPD. Je größer der Umfang des Kopfes ist, der die IPL passiert hat, desto weniger schwierig gestaltet sich die OPD und umso größer ist deren Gelingen.

Key words

translabial ultrasound - operative vaginal delivery - infrapubic line

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