Hans Rajvi, Reddy Deepa, Shetty Jyothi
Department of Obstetrics & Gynaecology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal Karnataka 576104, India.
Eur J Obstet Gynecol Reprod Biol. 2025 Feb;305:125-131. doi: 10.1016/j.ejogrb.2024.12.014. Epub 2024 Dec 10.
Over the past decade, intrapartum ultrasound (ITU) has been in the global limelight for labour monitoring. The use of the same in clinical settings of low- and middle-income countries (LMIC's) however, is limited. Till date, angle of progression (AOP) stands as the most studied parameter. Very few studies, most from developed countries, have shown that other ITU measurements could also hold relevance to labour and delivery. In recent times, serial ITU has also garnered some attention and could possibly be a better predictor of labour outcome.
This study aimed to compare the predictive accuracies of AOP and head PD for vaginal delivery and to investigate whether the rate of change of serially measured AOP and head PD in the first stage is predictive of vaginal delivery.
A prospective observational study was conducted on 90 nulliparous women between April 2023 and July 2024 at a tertiary teaching hospital in South India. Participants had singleton pregnancies in cephalic presentation between 37-40 weeks with regular contractions, and cervical dilation ≥ 3 cm. Exclusion criteria included prior LSCS and abnormal cardiotocography. Intrapartum ultrasound was performed twice, once at recruitment and 3-5 h apart, to measure AOP and PD. Statistical analysis included ROC curve plotting for diagnostic accuracy of AOP and PD in predicting vaginal delivery.
Of the 90 participants, 71 (78.9 %) delivered vaginally and 19 (21.1 %) had caesarean sections. AOP ≥ 120° and PD ≥ 2.7 cm at ≥ 6 cm cervical dilation showed a strong correlation with vaginal delivery, with sensitivity and specificity of 70.4 % and 94.7 %, and 63.4 % and 89.5 % respectively. Change (delta) in AOP > 10° had the highest diagnostic accuracy (81 %), with a positive predictive value of 92.2 %.
ITU offers valuable insights into labour progression. AOP and PD, particularly at cervical dilation of ≥ 6 cm, are predictive of vaginal delivery. Delta AOP serves as the most accurate predictor. Incorporating ITU into routine labour management enhances clinical decision-making, helping reduce unnecessary interventions and caesarean deliveries.
在过去十年中，产时超声（ITU）在全球范围内成为分娩监测的焦点。然而，在低收入和中等收入国家（LMIC）的临床环境中，其应用有限。迄今为止，进展角度（AOP）是研究最多的参数。很少有研究（大多数来自发达国家）表明，其他ITU测量值也可能与分娩相关。近年来，连续ITU也受到了一些关注，并且可能是分娩结局的更好预测指标。
本研究旨在比较AOP和头部双顶径（PD）对阴道分娩的预测准确性，并调查第一产程中连续测量的AOP和头部PD的变化率是否可预测阴道分娩。
2023年4月至2024年7月，在印度南部的一家三级教学医院对90名未生育过的妇女进行了一项前瞻性观察研究。参与者为单胎妊娠、头先露、孕周在37 - 40周之间、有规律宫缩且宫颈扩张≥3 cm。排除标准包括既往剖宫产史和异常胎心监护。产时超声检查进行两次，一次在入组时，另一次在3 - 5小时后，以测量AOP和PD。统计分析包括绘制ROC曲线，以评估AOP和PD在预测阴道分娩方面的诊断准确性。
90名参与者中，71名（78.9%）经阴道分娩，19名（21.1%）行剖宫产。宫颈扩张≥6 cm时，AOP≥120°和PD≥2.7 cm与阴道分娩有很强的相关性，敏感性和特异性分别为70.4%和94.7%，以及63.4%和89.5%。AOP变化（差值）>10°具有最高的诊断准确性（81%），阳性预测值为92.2%。
ITU为分娩进展提供了有价值的见解。AOP和PD，特别是在宫颈扩张≥6 cm时，可预测阴道分娩。AOP差值是最准确的预测指标。将ITU纳入常规分娩管理可加强临床决策，有助于减少不必要的干预和剖宫产。
