Failed Labor Clinical Trial
Official title:
Prediction of Mode of Delivery With Transperineal Ultrasound in Women With Prolonged First Stage of Labour. A Multicentre Study
Objectives
1. To assess if head-perineum distance and angle of progression measured with
transperineal ultrasound by the obstetrician on call can predict delivery mode in
primiparous women with prolonged first stage of labour.
2. To compare ultrasound assessments and clinical examinations.
Variables Digitally assessed cervical dilatation, fetal station and position Ultrasound
measured fetal head-perineum distance. Ultrasound measured angle of progression Ultrasound
assessed position
Possible confounders Ethnicity, maternal age, gestational age, BMI, induction of labour,
augmentation, epidural analgesia, birth weight, head circumference
A two-dimensional ultrasound measurement will be obtained with the ultrasound device
available in the delivery department. Fetal head descent is measured as the shortest
distance between the outer bony limit of the fetal skull and the perineum with a curved
transabdominal transducer placed transperineally between the labia in a transverse view (1).
The fetal descent will also be assessed measuring "angle of progression" as suggested by
Barbera et al. The ultrasound transducer will be placed on the perineum in a mid-sagittal
position between the labia below the pubic symphysis. The angle between a line through the
symphysis and a line from the posterior part of the symphysis tangentially to the fetal
skull contour will be measured (2)
A transabdominal scan will also be performed determining the fetal position as described
previously. Positions ≥ 02.30 and ≤ 03.30 hours should be recorded as left occiput
transverse and positions ≥ 08.30 and ≤ 09.30 as right occiput transverse. Positions > 03.30
and <08.30 should be recorded as occiput posterior and positions > 09.30 and < 02.30 as
occiput anterior.(3).
;
Observational Model: Cohort, Time Perspective: Prospective