The head direction to the angle of progression ratio: a quantitative parameter for intrapartum evaluation of cephalic malposition.

Pregnancy Female Humans Labor Presentation Fetus Retrospective Studies Ultrasonography, Prenatal / methods Prospective Studies
angle of progression cephalic malposition head direction intrapartum transperineal ultrasound labor and delivery management

Journal

American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609

Informations de publication

Date de publication:
01 2023
Historique:
received: 13 09 2022
accepted: 19 09 2022
pubmed: 27 9 2022
medline: 21 12 2022
entrez: 26 9 2022
Statut: ppublish

Résumé

No previous study has evaluated the transitions of intrapartum transperineal ultrasound parameters during labor progression in cephalic malposition. We aimed to quantitate the characteristic trends of fetal head position and descent in cephalic malposition by analyzing the transitions of intrapartum transperineal ultrasound parameters and explore an indicator associated with the degree of cephalic malposition. We retrospectively analyzed pregnant women who delivered at term from January 2018 to December 2020 at the University of Tokyo Hospital. The fetal occipital position was classified as occiput anterior and nonocciput anterior according to the fetal occipital angle of 0° to 75° and 75° to 180°, respectively. Fetal occipital angle was defined by the midline angle and position of the ocular orbit. The differences in the trends of head direction, head-symphysis distance, and progression distance relative to the angle of progression between occiput anterior and nonocciput anterior cases were evaluated. In addition, the parameters that showed differences were analyzed to evaluate their relationship to the degree of cephalic malposition. A total of 502 images (occiput anterior, 319; nonocciput anterior, 183) met the inclusion criteria. The distribution of head direction values relative to the angle of progression was smaller in the nonocciput anterior group than in the occiput anterior group, whereas the head-symphysis distance and progression distance values relative to the angle of progression showed no difference in their distribution between the occiput anterior and nonocciput anterior groups. The ratio of head direction to the angle of progression was significantly smaller in the nonocciput anterior group than in the occiput anterior group (median [interquartile range], 0.03 [-0.02 to 0.10] vs 0.21 [0.12-0.28]; P<.0001). Furthermore, this ratio was negatively correlated with fetal occipital angle (Spearman correlation coefficient, -0.66). Our results indicated that the head direction to angle of progression ratio reflects the deviation in the fetal head direction toward the maternal dorsal side, and decreases in proportion to the degree of cephalic malposition. This concept of deviation in the head direction as an indicator for evaluating cephalic malposition with intrapartum transperineal ultrasound may contribute to improving labor management in the case of cephalic malposition.

Sections du résumé

BACKGROUND
No previous study has evaluated the transitions of intrapartum transperineal ultrasound parameters during labor progression in cephalic malposition.
OBJECTIVE
We aimed to quantitate the characteristic trends of fetal head position and descent in cephalic malposition by analyzing the transitions of intrapartum transperineal ultrasound parameters and explore an indicator associated with the degree of cephalic malposition.
STUDY DESIGN
We retrospectively analyzed pregnant women who delivered at term from January 2018 to December 2020 at the University of Tokyo Hospital. The fetal occipital position was classified as occiput anterior and nonocciput anterior according to the fetal occipital angle of 0° to 75° and 75° to 180°, respectively. Fetal occipital angle was defined by the midline angle and position of the ocular orbit. The differences in the trends of head direction, head-symphysis distance, and progression distance relative to the angle of progression between occiput anterior and nonocciput anterior cases were evaluated. In addition, the parameters that showed differences were analyzed to evaluate their relationship to the degree of cephalic malposition.
RESULTS
A total of 502 images (occiput anterior, 319; nonocciput anterior, 183) met the inclusion criteria. The distribution of head direction values relative to the angle of progression was smaller in the nonocciput anterior group than in the occiput anterior group, whereas the head-symphysis distance and progression distance values relative to the angle of progression showed no difference in their distribution between the occiput anterior and nonocciput anterior groups. The ratio of head direction to the angle of progression was significantly smaller in the nonocciput anterior group than in the occiput anterior group (median [interquartile range], 0.03 [-0.02 to 0.10] vs 0.21 [0.12-0.28]; P<.0001). Furthermore, this ratio was negatively correlated with fetal occipital angle (Spearman correlation coefficient, -0.66).
CONCLUSION
Our results indicated that the head direction to angle of progression ratio reflects the deviation in the fetal head direction toward the maternal dorsal side, and decreases in proportion to the degree of cephalic malposition. This concept of deviation in the head direction as an indicator for evaluating cephalic malposition with intrapartum transperineal ultrasound may contribute to improving labor management in the case of cephalic malposition.

Identifiants

DOI: 10.1016/j.ajogmf.2022.100755 PMID: 36155110
pubmed: 36155110
pii: S2589-9333(22)00186-0
doi: 10.1016/j.ajogmf.2022.100755
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

100755

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Eriko Yano (E)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Takayuki Iriyama (T)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga). Electronic address: iriyama-tky@umin.ac.jp.

Seisuke Sayama (S)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Yu Ariyosi (Y)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Naoya Akiba (N)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Mari Ichinose (M)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Masatake Toshimitsu (M)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Takahiro Seyama (T)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Kenbun Sone (K)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Keiichi Kumasawa (K)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Takeshi Nagamatsu (T)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

Toshio Nakayama (T)

Department of Obstetrics and Gynecology, Sanno Hospital, Tokyo, Japan (Dr Nakayama).

Koichi Kobayashi (K)

Department of Obstetrics and Gynecology, Tokyo Yamate Medical Center, Tokyo, Japan (Dr Kobayashi).

Yutaka Osuga (Y)

Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Drs Yano, Iriyama, Sayama, Ariyosi, Akiba, Ichinose, Toshimitsu, Seyama, Sone, Kumasawa, Nagamatsu, and Osuga).

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › The head direction to the angle of progression...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The head direction to the angle of progression...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Travail obstétrical › Présentation foetale › The head direction to the angle of progression...
questionsmedicales.fr › Structures de l'embryon › Foetus › The head direction to the angle of progression...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The head direction to the angle of progression...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic gynécologique et obstétrique › Diagnostic prénatal › Échographie prénatale › The head direction to the angle of progression...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › The head direction to the angle of progression...