Obstetric and Gynecology Specialist Physician, Department of Gynecologic Oncology, Basaksehir Cam ve Sakura City Training and Research Hospital, İstanbul, Türkiye.
Obstetrics and Gynaecology Department, Istanbul University-Cerrahpasa, The Cerrahpasa Faculty of Medicine, Istanbul, Türkiye.
J Perinat Med. 2024 Sep 6;52(9):955-959. doi: 10.1515/jpm-2024-0214. Print 2024 Nov 26.
Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict a successful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score.
This prospective study included consecutive nulliparous pregnant women whose gestational age was 41 weeks and 1-6 days (late-term). The AoP was measured at least three times and their means were calculated.
During the study period, data of 150 women were included in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration of labour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %.
AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100° is associated with a high rate of vaginal delivery.
预测阴道分娩的成功率是预防母婴不良结局的一个重要问题。本研究旨在探讨在低（4>） Bishop 评分的足月初产妇中，经诱导分娩（IoL）后，测量进展角度（AoP）是否可以预测阴道分娩的成功率。
本前瞻性研究纳入了连续的足月初产妇，其孕周为 41 周加 1-6 天（晚期）。至少测量 AoP 三次并计算其平均值。
在研究期间，150 名妇女的数据被纳入最终分析。38 名妇女因进展不良（n=30）或 NRGHR（n=8）而行剖宫产，而其余 112 名妇女行阴道分娩，其中 4 名需要真空抽吸。两组在年龄、孕周、BMI、估计胎儿体重和出生体重方面相似。行阴道分娩的妇女与行剖宫产的妇女在超声 AoP 较大（113.8±11.9° vs. 98.1±10.9°，p=0.0001）、地诺前列酮使用时间较短、宫缩开始时间较短和产程时间较短方面存在显著差异。在 ROC 分析中，AoP 的截断值为 100°时，阴道分娩成功率预测值为 96%，特异性为 63%。
AoP 可能是预测足月初产妇经诱导分娩后阴道分娩成功率的有用超声参数；AoP 大于 100°与阴道分娩率高相关。
