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DOI: 10.1055/s-0043-122242
Ultraschall unter der Geburt: Eine systematische Analyse des Höhenstandes des kindlichen Kopfes in der Eröffnungsperiode der Geburt
Intrapartum Translabial Ultrasound: A Systematic Analysis of The Fetal Head Station in The First Stage of LaborPublication History
received 09 March 2017
accepted 25 October 2017
Publication Date:
15 December 2017 (online)
![](https://www.thieme-connect.de/media/zgn/201801/lookinside/thumbnails/03-2017-0149_10-1055-s-0043-122242-1.jpg)
Zusammenfassung
Einleitung Die Höhenstandsbestimmung des fetalen Kopfes hat Einfluss auf das geburtshilfliche Management. Ziel der Studie war es mithilfe des angle of progression (AOP) in der Eröffnungsphase eine Aussage über Geburtsdauer und Geburtsmodus zu treffen.
Methodik Dies war eine prospektive Studie. Einschlusskriterien waren Einlingsschwangerschaften, spontan-vaginale Geburt, fetale Schädellage, Primi- und Multiparae und Patientinnen mit Periduralanästhesie (PDA). Einflussfaktoren wie Kopfumfang, Geburtsgewicht, Oxytocingabe, Periduralanästhesie, Parität wurden bestimmt und den Einfluss auf den AOP analysiert sowie drei Berechnungsvarianten erstellt.
Ergebnis 30 Patientinnen wurden eingeschlossen. Der Anteil an spontan-vaginalen Geburten lag bei 90%, die der vaginal-operativen bei 10%. Der Durchschnittswinkel des AOP lag bei den spontan-vaginalen Entbindungen bei einer Muttermundsweite <5 cm bei 100,9°, bei >5 cm bei 125,3°. Bei den vaginal-operativen Entbindungen lag der Durchschnittswinkel bei <5 cm bei 93°, bei>5 cm bei 113,9°. Nur die erste Berechnung AOP 1/Muttermundöffnung in cm bei der 1. Messung zeigt eine Tendenz zur Geburtsdauer, aber nicht zum Entbindungsmodus.
Fazit für die Praxis Die prognostische Aussagefähigkeit des Ultraschalls unter der Geburt in der Eröffnungsphase lässt Tendenzen zur Geburtsdauer erkennen.
Abstract
Introduction This prospective study aimed to define the angle of progression (AOP) in relation to the height position of the fetal head during the first stage of labour. It was investigated if it is possible to predict the mode of delivery or the duration of labour by AOP.
Methods Influencing factors on delivery were head circumference, birth-weight, administration of oxytocin, epidural anaesthesia (EA) and parity, and their impact on AOP was analysed. AOP was calculated using three different formulas. Inclusion criteria were vaginal delivery of singletons in cephalic, occipito-anterior presentation.
Results 30/80 recruited women met the study criteria. 90% delivered spontaneously vaginally, 10% had instrument-assisted vaginal delivery. The average AOP in spontaneous vaginal deliveries was 100.9° at cervical dilation less than 5 cm, and 125.3° at cervical dilatation more than 5 cm. The average AOP in instrument-assisted births was 93° and 113.9° when the cervical os was less than 5 cm and more than 5 cm, respectively. Analysis identified a predictive trend towards the duration of labour only by use of the first AOP formula but not regarding the mode of delivery.
Conclusion Sonographically assessed AOP during first stage of labour indicates trends regarding the duration of labour.
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Literatur
- 1 ACOG. Operative vaginal Delivery. ACOG Practice Bulletin (No. 17); 2000
- 2 Barbera A, > Becker T, Macfarland H. et al. Assessment of fetal head descent in labor with transperineal ultrasound. Teaching DVD. ACOG; 2003: 176
- 3 Barbera A, Pombar X, Perugino G. A new method to assess fetal head descent in labor. Ultrasound Obstet Gynecol 2009; 33: 313-319
- 4 Akmal S, Kametas N, Tsoi E. et al. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003; 21: 437-440
- 5 Dupuis O, Silveira R, Corinne D. et al. Fetal head position during the second stage of labor: comparison of digital vaginal examination and transabdominal ultrasonographic examination. Eur J Obstet Gynecol Reprod Biol 2005; 123: 193-197
- 6 Sherer DM, Abulafia O. Intrapartum assessment of fetal head engagement: comparison between transvaginal digital andtransabdominal ultrasound determinations. Ultrasound Obstet Gynecol 2003; 21: 430-436
- 7 Yuce T, Kalafat E, Koc A. Transperineal ultrasonography for labor management: accuracy and reliability. Acta Obstet Gynecol Scand 2015; 94: 760-765
- 8 Levy R, Zaks S, Ben-Arie A. et al. Can angle of progression in pregnant women before onset of labor predict mode of delivery?. Ultrasound Obstet Gynecol 2012; 40: 332-337
- 9 Kalache KD, Dückelmann AM, Michaelis SA. et al. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery?. Ultrasound Obstet Gynecol 2009; 33: 326-330
- 10 Torkildsen E, Salvesen KÅ, Eggebø TM. Prediction of delivery mode with transperineal ultrasound in women with prolonged first stage of labor. Ultrasound Obstet Gynecol 2011; 37: 702-708
- 11 Marsoosi V, Pirjani R, Mansouri B. et al. Role of ‘angle of progression’ in prediction of delivery mode. J Obstet Gynaecol Res 2015; 41: 1693-1699
- 12 ACOG technical bulletin. Dystocia and the augmentation of labor. Int J Gynaecol Obstet 1996; 53: 73-80
- 13 Rozenberg P, Porcher R, Salomon LJ. et al. Comparison of the learning curves of digital examination and transabdominal sonography for the determination of fetal head position during labor. Ultrasound Obstet Gynecol 2008; 31: 332-337
- 14 Dueckelmann AM, Bamberg C, Michaelis M. et al. Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet Gynecol 2010; 35: 216-222
- 15 Caldwell WE, Moloy HS. Anatomical variations in the female pelvis and their effect in labor with a suggested classification. Am J Obstet Gynecol 1933; 26: 439
- 16 Kirchhoff A. Beckenanomalien – ihre klinische Bedeutung heute. Diagnostik und Konsequenzen. Gynäkol Prax 1983; 7: 19-28
- 17 Wischnik A, Lehmann KJ, Zahn K. et al. Veränderung der pelvinen Anatomie in 8 Jahrzenten – Computertomographische Untersuchungen zu geburtshilflich relevanter Beckenmasse. Z Geburtshilfe Perinatol 1992; 196: 49-54
- 18 Krauss T, Osmers R, Westerfeld S. et al. Bedeutung des Langen Beckens nach Kirchhoff in der heutigen Geburtshilfe. Z Geburtshilfe Perinatol 1997; 201: 247-252
- 19 Bamberg C, Scheuermann S, Slowinski T. et al. Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound. Ultrasound Obstet Gynecol 2011; 37: 712-716
- 20 Henrich W, Dudenhausen J, Fuchs I. et al. Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction. Ultrasound Obstet Gynecol 2006; 28: 753-760