The Experts below are selected from a list of 2697 Experts worldwide ranked by ideXlab platform
G Pilu - One of the best experts on this subject based on the ideXlab platform.
-
a simple sonographic finding is associated with a successful vacuum application the fetal Occiput or forehead sign
American Journal of Obstetrics & Gynecology MFM, 2019Co-Authors: F Ellussi, T Ghi, G Salsi, L Cariello, A Youssef, Giuliana Simonazzi, I Cataneo, G PiluAbstract:Background Intrapartum ultrasound scanning has been proposed as an ancillary tool in the decision-making process of instrumental vaginal delivery. Objective The purpose of this study was to evaluate the correlation between the sonographic visualization with a transperineal scan of the fetal Occiput or forehead distal to the pubic symphysis with anterior or posterior presentation, respectively (fetal Occiput or forehead sign), and the outcome of a vacuum delivery. Study Design We conducted a retrospective cohort study of patients who underwent a vacuum application in our hospital from 2011–2017, excluding outlet applications. In each case, a preliminary transperineal scan was performed to confirm fetal presentation and position and to demonstrate the presence or absence of the fetal Occiput or forehead sign. The head direction, angle of progression, and the head perineum distance were also noted. The primary outcome measure was the success of the vacuum. The secondary outcome measures included fetal complications and perineal lacerations. Results A total of 196 consecutive patients were enrolled in the study. The Occiput or forehead sign was present in 150 and was associated with a successful vaginal extraction in all cases. Of the 46 cases without the sign, 5 babies (10.8%) were delivered by cesarean section after a failed vacuum (P=.0006). The Occiput or forehead sign was also associated with fewer grade 3–4 perineal lacerations (10.7% vs 35.7%; P=.0005) and cephalohematomas, although the difference was not statistically significant (1.4% vs 4.3%). There was a good correlation between the Occiput or forehead sign and the other sonographic methods that previously had been proposed to predict a successful vacuum extraction, such as head direction, angle of progression, and head perineum distance. Conclusion In our hands, the fetal Occiput or forehead sign was associated strongly with successful vacuum application and with a very low rate of maternal and fetal complications.
-
randomised italian sonography for Occiput position trial ante vacuum r i s pos t a
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: T Ghi, G Pilu, Giuseppe Rizzo, Ianca Masturzo, A Dallasta, Eatrice Tassis, Maurizio Martinelli, N Volpe, F Prefumo, L CarielloAbstract:OBJECTIVE To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. METHODS Randomised Italian Sonography for Occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. RESULTS On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-Occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of Occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. CONCLUSIONS Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
narrow subpubic arch angle is associated with higher risk of persistent Occiput posterior position at delivery
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, G Pilu, T Frusca, Federica Martelli, E Aiello, Nicola Rizzo, D Arduini, Giuseppe RizzoAbstract:Objective To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal Occiput position at delivery and the mode of delivery. Methods Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal Occiput position at delivery and the incidence of operative delivery were investigated. Results Overall, 368 women were included in the study. Fetal position at delivery was Occiput anterior in 339 (92.1%) cases and Occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the Occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal Occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°. Conclusion A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
-
the Occiput spine angle a new sonographic index of fetal head deflexion during the first stage of labor
American Journal of Obstetrics and Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, C Azzarone, J Krsmanovic, Laura Franchi, Jacopo Lenzi, Maria Pia Fantini, T Frusca, G PiluAbstract:Background Fetal head "attitude" (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor, although the use of ultrasound to support clinical diagnosis has been recently reported. Objectives The aims of this study were: (1) to quantify the degree of fetal head deflection via the use of sonography during the first stage of labor; and (2) to determine whether a parameter derived from ultrasound examination (the Occiput-spine angle) has a relationship with the course and outcome of labor. Study Design This was a prospective multicentric, cross-sectional study conducted at the Maternity Unit of the University of Bologna and Parma from January 2014 to April 2015. A nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to transabdominal ultrasound during the first stage of labor. If fetal position was Occiput anterior or transverse, the angle between the fetal Occiput and the cervical spine (the Occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the Occiput spine-angle were performed offline by 2 operators who were blinded to the labor outcome. The intra- and interobserver reproducibility and the correlation between the Occiput-spine angle and the mode of delivery were evaluated. Results A total of 108 pregnant women were recruited, 79 of which underwent a spontaneous vaginal delivery and 29 were submitted to obstetric intervention (19 cesarean delivery and 10 instrumental vaginal deliveries). The mean value of the Occiput-spine angle measured in the active phase of the first stage was 126° ± 9.8° (SD). The Occiput-spine angle measurement showed a very good intraobserver ( r = 0.86; 95% confidence interval [95% CI] 0.80–0.90) and a fair-to-good interobserver ( r = 0.64; 95% CI 0.51–0.74) agreement. The Occiput-spine angle was significantly narrower in women who underwent obstetric intervention (cesarean or vacuum delivery) due to labor arrest (121° ± 10.5° vs 127° ± 9.4°, P = .03). Multivariable logistic regression analysis showed that narrow Occiput-spine angle values (OR 1.08; 95% CI 1.00−1.16; P = .04) and nulliparity (OR 16.06; 95% CI 1.71−150.65; P = .02) were independent risk factors for operative delivery. A larger Occiput-spine angle width (i.e., >125°) showed to be significantly associated with a shorter duration of labor (hazard ratio = 1.62; 95% CI 1.07−2.45; P = .02). Conclusion We described herein the "Occiput-spine angle," a new sonographic parameter to assess fetal head deflection during labor. Fetuses with smaller Occiput-spine angle (
-
sonographic assessment of fetal Occiput position during the second stage of labor how reliable is the transperineal approach
Journal of Maternal-fetal & Neonatal Medicine, 2015Co-Authors: T Ghi, F Ellussi, T M Eggebo, F Tondi, G Pacella, G Salsi, L Cariello, A Piastra, A Youssef, G PiluAbstract:AbstractObjective: To compare the accuracy of transperineal (TP) ultrasound with transabdominal (TA) approach in the sonographic assessment of fetal Occiput position during the second stage of labour.Methods: A series of low-risk women at term attending the labour ward of three university hospitals were prospectively recruited for the purpose of this study. During the second stage of labor patients were evaluated first by TP and than by TA ultrasound to determine the fetal position. The Occiput position was labelled as DOA (direct Occiput anterior), ROA (right Occiput anterior), LOA (left Occiput anterior), DOP (direct Occiput posterior), ROP (right Occiput posterior), LOP (left Occiput posterior), ROT (right occuput transverse) and LOT (left Occiput transverse). The agreement between the two techniques was assessed.Results: Overall 80 patients were recruited in the study group. Ultrasound examination was performed at 21(±8) minutes from the beginning of the active pushing. The ultrasound findings of the ...
A Youssef - One of the best experts on this subject based on the ideXlab platform.
-
a simple sonographic finding is associated with a successful vacuum application the fetal Occiput or forehead sign
American Journal of Obstetrics & Gynecology MFM, 2019Co-Authors: F Ellussi, T Ghi, G Salsi, L Cariello, A Youssef, Giuliana Simonazzi, I Cataneo, G PiluAbstract:Background Intrapartum ultrasound scanning has been proposed as an ancillary tool in the decision-making process of instrumental vaginal delivery. Objective The purpose of this study was to evaluate the correlation between the sonographic visualization with a transperineal scan of the fetal Occiput or forehead distal to the pubic symphysis with anterior or posterior presentation, respectively (fetal Occiput or forehead sign), and the outcome of a vacuum delivery. Study Design We conducted a retrospective cohort study of patients who underwent a vacuum application in our hospital from 2011–2017, excluding outlet applications. In each case, a preliminary transperineal scan was performed to confirm fetal presentation and position and to demonstrate the presence or absence of the fetal Occiput or forehead sign. The head direction, angle of progression, and the head perineum distance were also noted. The primary outcome measure was the success of the vacuum. The secondary outcome measures included fetal complications and perineal lacerations. Results A total of 196 consecutive patients were enrolled in the study. The Occiput or forehead sign was present in 150 and was associated with a successful vaginal extraction in all cases. Of the 46 cases without the sign, 5 babies (10.8%) were delivered by cesarean section after a failed vacuum (P=.0006). The Occiput or forehead sign was also associated with fewer grade 3–4 perineal lacerations (10.7% vs 35.7%; P=.0005) and cephalohematomas, although the difference was not statistically significant (1.4% vs 4.3%). There was a good correlation between the Occiput or forehead sign and the other sonographic methods that previously had been proposed to predict a successful vacuum extraction, such as head direction, angle of progression, and head perineum distance. Conclusion In our hands, the fetal Occiput or forehead sign was associated strongly with successful vacuum application and with a very low rate of maternal and fetal complications.
-
how reliable is fetal Occiput and spine position assessment prior to induction of labor
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: R Kamel, A YoussefAbstract:OBJECTIVES To assess the reliability of fetal Occiput and spine position determination in nulliparous women prior to induction of labor (IOL), and to evaluate identification of fetal Occiput and spine positions prior to IOL in the prediction of labor outcome. METHODS A series of 136 nulliparous women were recruited prospectively, immediately after the decision to perform IOL was made. Transabdominal ultrasound was performed to determine fetal head and spine positions. After at least 1 h, and prior to IOL, fetal Occiput and spine positions were reassessed. Fetal Occiput and spine positions were then compared between women who underwent vaginal delivery and those who delivered by Cesarean section. RESULTS On the first and second assessments, respectively, fetal Occiput position was anterior in 55 (40.4%) and 62 (45.6%) women, transverse in 52 (38.2%) and 49 (36.0%) women, and posterior in 29 (21.3%) and 25 (18.4%) women, while fetal spine position was anterior in 58 (42.6%) and 52 (38.2%) women, transverse in 42 (30.9%) and 50 (36.8%) women, and posterior in 36 (26.5%) and 34 (25.0%) women. Discordance between the first and second assessments of fetal Occiput position was identified in 34 (25.0%) women, whereas discordance of fetal spine position was observed in 40 (29.4%) women. The incidence of fetal Occiput posterior position in women undergoing Cesarean section was comparable to that in the vaginal-delivery group (19 (18.8%) vs 6 (17.1%); P = 0.826), which was similarly the case for fetal posterior spine position (27 (26.7%) vs 7 (20%); P = 0.428). Women with fetal Occiput posterior position had a longer induction-to-delivery interval in comparison to those with non-Occiput posterior fetal position (1786 ± 805 vs 1347 ± 784 min; P = 0.013). CONCLUSIONS Fetal Occiput and spine positions are dynamic in a considerable proportion of women undergoing IOL, and their assessment does not seem to correlate with mode of delivery. Occiput and spine position assessment in women prior to IOL is unlikely to be clinically useful. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
narrow subpubic arch angle is associated with higher risk of persistent Occiput posterior position at delivery
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, G Pilu, T Frusca, Federica Martelli, E Aiello, Nicola Rizzo, D Arduini, Giuseppe RizzoAbstract:Objective To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal Occiput position at delivery and the mode of delivery. Methods Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal Occiput position at delivery and the incidence of operative delivery were investigated. Results Overall, 368 women were included in the study. Fetal position at delivery was Occiput anterior in 339 (92.1%) cases and Occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the Occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal Occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°. Conclusion A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
-
the Occiput spine angle a new sonographic index of fetal head deflexion during the first stage of labor
American Journal of Obstetrics and Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, C Azzarone, J Krsmanovic, Laura Franchi, Jacopo Lenzi, Maria Pia Fantini, T Frusca, G PiluAbstract:Background Fetal head "attitude" (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor, although the use of ultrasound to support clinical diagnosis has been recently reported. Objectives The aims of this study were: (1) to quantify the degree of fetal head deflection via the use of sonography during the first stage of labor; and (2) to determine whether a parameter derived from ultrasound examination (the Occiput-spine angle) has a relationship with the course and outcome of labor. Study Design This was a prospective multicentric, cross-sectional study conducted at the Maternity Unit of the University of Bologna and Parma from January 2014 to April 2015. A nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to transabdominal ultrasound during the first stage of labor. If fetal position was Occiput anterior or transverse, the angle between the fetal Occiput and the cervical spine (the Occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the Occiput spine-angle were performed offline by 2 operators who were blinded to the labor outcome. The intra- and interobserver reproducibility and the correlation between the Occiput-spine angle and the mode of delivery were evaluated. Results A total of 108 pregnant women were recruited, 79 of which underwent a spontaneous vaginal delivery and 29 were submitted to obstetric intervention (19 cesarean delivery and 10 instrumental vaginal deliveries). The mean value of the Occiput-spine angle measured in the active phase of the first stage was 126° ± 9.8° (SD). The Occiput-spine angle measurement showed a very good intraobserver ( r = 0.86; 95% confidence interval [95% CI] 0.80–0.90) and a fair-to-good interobserver ( r = 0.64; 95% CI 0.51–0.74) agreement. The Occiput-spine angle was significantly narrower in women who underwent obstetric intervention (cesarean or vacuum delivery) due to labor arrest (121° ± 10.5° vs 127° ± 9.4°, P = .03). Multivariable logistic regression analysis showed that narrow Occiput-spine angle values (OR 1.08; 95% CI 1.00−1.16; P = .04) and nulliparity (OR 16.06; 95% CI 1.71−150.65; P = .02) were independent risk factors for operative delivery. A larger Occiput-spine angle width (i.e., >125°) showed to be significantly associated with a shorter duration of labor (hazard ratio = 1.62; 95% CI 1.07−2.45; P = .02). Conclusion We described herein the "Occiput-spine angle," a new sonographic parameter to assess fetal head deflection during labor. Fetuses with smaller Occiput-spine angle (
-
sonographic assessment of fetal Occiput position during the second stage of labor how reliable is the transperineal approach
Journal of Maternal-fetal & Neonatal Medicine, 2015Co-Authors: T Ghi, F Ellussi, T M Eggebo, F Tondi, G Pacella, G Salsi, L Cariello, A Piastra, A Youssef, G PiluAbstract:AbstractObjective: To compare the accuracy of transperineal (TP) ultrasound with transabdominal (TA) approach in the sonographic assessment of fetal Occiput position during the second stage of labour.Methods: A series of low-risk women at term attending the labour ward of three university hospitals were prospectively recruited for the purpose of this study. During the second stage of labor patients were evaluated first by TP and than by TA ultrasound to determine the fetal position. The Occiput position was labelled as DOA (direct Occiput anterior), ROA (right Occiput anterior), LOA (left Occiput anterior), DOP (direct Occiput posterior), ROP (right Occiput posterior), LOP (left Occiput posterior), ROT (right occuput transverse) and LOT (left Occiput transverse). The agreement between the two techniques was assessed.Results: Overall 80 patients were recruited in the study group. Ultrasound examination was performed at 21(±8) minutes from the beginning of the active pushing. The ultrasound findings of the ...
T Ghi - One of the best experts on this subject based on the ideXlab platform.
-
a simple sonographic finding is associated with a successful vacuum application the fetal Occiput or forehead sign
American Journal of Obstetrics & Gynecology MFM, 2019Co-Authors: F Ellussi, T Ghi, G Salsi, L Cariello, A Youssef, Giuliana Simonazzi, I Cataneo, G PiluAbstract:Background Intrapartum ultrasound scanning has been proposed as an ancillary tool in the decision-making process of instrumental vaginal delivery. Objective The purpose of this study was to evaluate the correlation between the sonographic visualization with a transperineal scan of the fetal Occiput or forehead distal to the pubic symphysis with anterior or posterior presentation, respectively (fetal Occiput or forehead sign), and the outcome of a vacuum delivery. Study Design We conducted a retrospective cohort study of patients who underwent a vacuum application in our hospital from 2011–2017, excluding outlet applications. In each case, a preliminary transperineal scan was performed to confirm fetal presentation and position and to demonstrate the presence or absence of the fetal Occiput or forehead sign. The head direction, angle of progression, and the head perineum distance were also noted. The primary outcome measure was the success of the vacuum. The secondary outcome measures included fetal complications and perineal lacerations. Results A total of 196 consecutive patients were enrolled in the study. The Occiput or forehead sign was present in 150 and was associated with a successful vaginal extraction in all cases. Of the 46 cases without the sign, 5 babies (10.8%) were delivered by cesarean section after a failed vacuum (P=.0006). The Occiput or forehead sign was also associated with fewer grade 3–4 perineal lacerations (10.7% vs 35.7%; P=.0005) and cephalohematomas, although the difference was not statistically significant (1.4% vs 4.3%). There was a good correlation between the Occiput or forehead sign and the other sonographic methods that previously had been proposed to predict a successful vacuum extraction, such as head direction, angle of progression, and head perineum distance. Conclusion In our hands, the fetal Occiput or forehead sign was associated strongly with successful vacuum application and with a very low rate of maternal and fetal complications.
-
randomised italian sonography for Occiput position trial ante vacuum r i s pos t a
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: T Ghi, G Pilu, Giuseppe Rizzo, Ianca Masturzo, A Dallasta, Eatrice Tassis, Maurizio Martinelli, N Volpe, F Prefumo, L CarielloAbstract:OBJECTIVE To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. METHODS Randomised Italian Sonography for Occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. RESULTS On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-Occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of Occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. CONCLUSIONS Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
narrow subpubic arch angle is associated with higher risk of persistent Occiput posterior position at delivery
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, G Pilu, T Frusca, Federica Martelli, E Aiello, Nicola Rizzo, D Arduini, Giuseppe RizzoAbstract:Objective To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal Occiput position at delivery and the mode of delivery. Methods Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal Occiput position at delivery and the incidence of operative delivery were investigated. Results Overall, 368 women were included in the study. Fetal position at delivery was Occiput anterior in 339 (92.1%) cases and Occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the Occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal Occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°. Conclusion A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
-
the Occiput spine angle a new sonographic index of fetal head deflexion during the first stage of labor
American Journal of Obstetrics and Gynecology, 2016Co-Authors: T Ghi, F Ellussi, A Youssef, C Azzarone, J Krsmanovic, Laura Franchi, Jacopo Lenzi, Maria Pia Fantini, T Frusca, G PiluAbstract:Background Fetal head "attitude" (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor, although the use of ultrasound to support clinical diagnosis has been recently reported. Objectives The aims of this study were: (1) to quantify the degree of fetal head deflection via the use of sonography during the first stage of labor; and (2) to determine whether a parameter derived from ultrasound examination (the Occiput-spine angle) has a relationship with the course and outcome of labor. Study Design This was a prospective multicentric, cross-sectional study conducted at the Maternity Unit of the University of Bologna and Parma from January 2014 to April 2015. A nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to transabdominal ultrasound during the first stage of labor. If fetal position was Occiput anterior or transverse, the angle between the fetal Occiput and the cervical spine (the Occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the Occiput spine-angle were performed offline by 2 operators who were blinded to the labor outcome. The intra- and interobserver reproducibility and the correlation between the Occiput-spine angle and the mode of delivery were evaluated. Results A total of 108 pregnant women were recruited, 79 of which underwent a spontaneous vaginal delivery and 29 were submitted to obstetric intervention (19 cesarean delivery and 10 instrumental vaginal deliveries). The mean value of the Occiput-spine angle measured in the active phase of the first stage was 126° ± 9.8° (SD). The Occiput-spine angle measurement showed a very good intraobserver ( r = 0.86; 95% confidence interval [95% CI] 0.80–0.90) and a fair-to-good interobserver ( r = 0.64; 95% CI 0.51–0.74) agreement. The Occiput-spine angle was significantly narrower in women who underwent obstetric intervention (cesarean or vacuum delivery) due to labor arrest (121° ± 10.5° vs 127° ± 9.4°, P = .03). Multivariable logistic regression analysis showed that narrow Occiput-spine angle values (OR 1.08; 95% CI 1.00−1.16; P = .04) and nulliparity (OR 16.06; 95% CI 1.71−150.65; P = .02) were independent risk factors for operative delivery. A larger Occiput-spine angle width (i.e., >125°) showed to be significantly associated with a shorter duration of labor (hazard ratio = 1.62; 95% CI 1.07−2.45; P = .02). Conclusion We described herein the "Occiput-spine angle," a new sonographic parameter to assess fetal head deflection during labor. Fetuses with smaller Occiput-spine angle (
-
sonographic assessment of fetal Occiput position during the second stage of labor how reliable is the transperineal approach
Journal of Maternal-fetal & Neonatal Medicine, 2015Co-Authors: T Ghi, F Ellussi, T M Eggebo, F Tondi, G Pacella, G Salsi, L Cariello, A Piastra, A Youssef, G PiluAbstract:AbstractObjective: To compare the accuracy of transperineal (TP) ultrasound with transabdominal (TA) approach in the sonographic assessment of fetal Occiput position during the second stage of labour.Methods: A series of low-risk women at term attending the labour ward of three university hospitals were prospectively recruited for the purpose of this study. During the second stage of labor patients were evaluated first by TP and than by TA ultrasound to determine the fetal position. The Occiput position was labelled as DOA (direct Occiput anterior), ROA (right Occiput anterior), LOA (left Occiput anterior), DOP (direct Occiput posterior), ROP (right Occiput posterior), LOP (left Occiput posterior), ROT (right occuput transverse) and LOT (left Occiput transverse). The agreement between the two techniques was assessed.Results: Overall 80 patients were recruited in the study group. Ultrasound examination was performed at 21(±8) minutes from the beginning of the active pushing. The ultrasound findings of the ...
Yvonne W Cheng - One of the best experts on this subject based on the ideXlab platform.
-
the association between persistent fetal Occiput posterior position and perinatal outcomes an example of propensity score and covariate distance matching
American Journal of Epidemiology, 2010Co-Authors: Yvonne W Cheng, Aaro Caughey, Ala Hubbard, Ira TageAbstract:In a retrospective cohort study of 18,880 full-term, cephalic singletons born in San Francisco, California, during 1976-2001, the authors used multivariable logistic regression (MVLR) and propensity score analysis (PSA) to examine the association between persistent fetal Occiput posterior (OP) position and perinatal outcomes. The principles and applications of these techniques are compared and discussed. Pregnancies with OP positions at delivery were compared with those with Occiput anterior positions. Perinatal outcomes were examined as adjusted odds ratios determined by MVLR and PSA and as risk differences determined by propensity score matched bootstrapping based on covariate distance. Persistent OP position was associated with operative delivery and maternal morbidity. The odds ratio estimates based on PSA were somewhat larger than those obtained with standard MVLR, and the confidence intervals were narrower. When statistical inference was evaluated with the permutation test, the results were more consistent with the PSA. These analyses demonstrate that PSA is likely to provide more precise estimates of exposure associations and more reliable statistical inferences than MVLR. The authors show that PSA can be extended with Mahalanobis distance matching to obtain estimates of risk difference between exposed and unexposed subjects that avoid violations of the experimental treatment assignment (positivity) assumption that is required for valid causal inference.
-
associated factors and outcomes of persistent Occiput posterior position a retrospective cohort study from 1976 to 2001
Journal of Maternal-fetal & Neonatal Medicine, 2006Co-Authors: Yvonne W Cheng, Ia L Shaffe, Aaro CaugheyAbstract:Objective. To identify maternal and fetal risk factors associated with persistent Occiput posterior position at delivery, and to examine the association of Occiput posterior position with subsequent obstetric outcomes.Methods. This is a retrospective cohort study of 30 839 term, cephalic, singleton births. Women with persistent Occiput posterior (OP) position at delivery were compared to those with Occiput anterior (OA) position. Demographics, obstetric history, and labor management were evaluated and subsequent obstetric outcomes examined. Potential confounding variables were controlled for using multivariate logistic regression analysis.Results. The overall frequency of OP position was 8.3% in the study population. When compared to Caucasians, a higher rate of OP was observed among African-Americans (OR = 1.4, 95% CI 1.25–1.64) while no other racial/ethnic differences were noted. Other associated factors included nulliparity, maternal age ≥35, gestational age ≥41 weeks, and birth weight >4000 g, as well...
-
the relationship of fetal position and ethnicity with shoulder dystocia and birth injury
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Yvonne W Cheng, Errol R Norwitz, Aaron B CaugheyAbstract:OBJECTIVE: The objective of this study was to examine factors associated with the occurrence of shoulder dystocia and subsequent perinatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of 29,612 consecutive term, singleton, vertex vaginal deliveries. The primary outcome was reported shoulder dystocia. Fetal position, ethnicity, and their interaction terms were examined along with maternal characteristics, induction and length of labor, operative vaginal delivery, epidural, and birth weight in both bivariate and multivariate analyses. RESULTS: Among women who met study criteria, 524 (1.8%) experienced a shoulder dystocia. African American women had the highest risk of shoulder dystocia (2.6%), compared with other races/ethnicities (P = .001). Women who delivered in Occiput posterior position were noted to have a lower risk for shoulder dystocia (1.1%) as compared with Occiput anterior position (1.8%, P = .046). However, in the setting of a shoulder dystocia, a higher risk of brachial plexus injury was observed in neonates delivered in Occiput posterior position (adjusted odds ratio 10.4, 95% confidence interval 3.03 to 35.88) by vacuum-assisted vaginal delivery (adjusted odds ratio 3.24, 95% confidence interval 1.37 to 7.67) and neonates weighing 4000 g or more (adjusted odds ratio 2.53, 95% confidence interval 1.09 to 5.85). CONCLUSION: Overall African American women have an increased risk of shoulder dystocia, but their neonates are not more likely to experience birth injury. Although Occiput posterior position has a protective effect for shoulder dystocia, the risk of brachial plexus injury is increased in the setting of a persistent Occiput posterior delivery. These factors should be used to consider a patient's prospective risk for shoulder dystocia and associated outcomes.
-
the association between persistent Occiput posterior position and neonatal outcomes
Obstetrics & Gynecology, 2006Co-Authors: Yvonne W Cheng, Ia L Shaffe, Aaro CaugheyAbstract:OBJECTIVE To examine the effect of persistent Occiput posterior position on neonatal outcome. METHODS This is a retrospective cohort study of 31,392 term, cephalic, singleton births. Women with neonates born in persistent Occiput posterior position at delivery were compared to those with Occiput anterior position. Women with Occiput transverse position were excluded. The association between Occiput posterior position and neonatal outcomes, including 5-minute Apgar scores, umbilical cord gases, meconium-stained amniotic fluid, meconium aspiration syndrome, birth trauma, admission to the intensive care nursery, and length of stay were examined using chi(2) and Student t tests. Potential confounders (maternal age, ethnicity, parity, gestational age, epidural anesthesia, labor induction, length of labor, meconium, chorioamnionitis, birth weight, and year of delivery) were controlled for by using multivariable logistic regression and linear regression analyses. RESULTS There were 2,591 (8.2%) neonates delivered in Occiput posterior position of the total cohort of 31,392 deliveries. Compared with Occiput anterior, neonates delivered in Occiput posterior position had higher risks for adverse outcomes, including 5-minute Apgar score less than 7 (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.17-1.91), acidemic umbilical cord gases (OR 2.05, 95% CI 1.52-2.77), meconium-stained amniotic fluid (OR 1.29, 95% CI 1.17-1.42), birth trauma (OR 1.77, 95% CI 1.22-2.57), admission to the intensive care nursery (OR 1.57, 95% CI 1.28-1.92), and longer neonatal stay in the hospital (OR 2.69, 95% CI 2.22-3.25). CONCLUSION Persistent Occiput posterior position at delivery is associated with higher risks of adverse neonatal outcomes compared with neonates delivered in the Occiput anterior position. This information may be important in counseling women who experience persistent Occiput posterior position in labor. LEVEL OF EVIDENCE II-2.
-
manual rotation of the fetal Occiput predictors of success and delivery
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Ia L Shaffe, Yvonne W Cheng, Jua Vargas, Russell K Laros, Aaro CaugheyAbstract:Objective The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal Occiput from Occiput posterior or transverse position. Study design A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal Occiput from Occiput posterior or Occiput transverse position. Successful rotation was defined as delivery in the Occiput anterior position. We examined maternal, fetal, and labor characteristics as predictors of both fetal position at delivery and cesarean delivery. Results Multiparity (odds ratio, 2.5; 95% CI, 1.5-3.8) and maternal age P 35 years, labor induction, and epidural usage were associated with higher rates of cesarean delivery. Conclusion After successful manual rotation of the fetal Occiput, women had lower cesarean delivery rates than women with unsuccessful rotations. Multiparity and maternal age of
Anthony G Visco - One of the best experts on this subject based on the ideXlab platform.
-
Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum assisted deliveries
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Kathry S Williams, Andrew F Hundley, Annamarie Connolly, Anthony G ViscoAbstract:Objective The purpose of this study was to determine whether an Occiput posterior (OP) fetal head position increases the risk for anal sphincter injury when compared with an Occiput anterior (OA) position in vacuum-assisted deliveries. Study design We conducted a retrospective cohort study of 393 vacuum-assisted singleton vaginal deliveries. Maternal demographics and obstetric and neonatal data were collected from an obstetric database and chart review. Results Within the OP group, 41.7% developed a third- or fourth-degree laceration compared with 22.0% in the OA group (OR 2.5, 95% CI 1.4-4.7). In a logistic regression model that controlled for BMI, race, nulliparity, length of second stage, episiotomy, birth weight, head circumference, and fetal head position, OP position was 4.0 times (95% CI 1.7-9.6) more likely to be associated with an anal sphincter injury than OA position. Conclusion Among vacuum deliveries, an OP head position confers an incrementally increased risk for anal sphincter injury over an OA position.
-
the impact of Occiput posterior fetal head position on the risk of anal sphincter injury in forceps assisted vaginal deliveries
American Journal of Obstetrics and Gynecology, 2005Co-Authors: Lorena Benavides, Andrew F Hundley, Jennifer M Wu, Thomas Ivester, Anthony G ViscoAbstract:Objective A forceps-assisted vaginal delivery is a well-recognized risk factor for anal sphincter injury. Some studies have shown that Occiput posterior (OP) fetal head position is also associated with an increased risk for third- or fourth-degree lacerations. The objective of this study was to assess whether OP position confers an incrementally increased risk for anal sphincter injury above that present with forceps deliveries. Study design This was a retrospective cohort study of 588 singleton, cephalic, forceps-assisted vaginal deliveries performed at our institution between January 1996 and October 2003. Maternal demographics, labor and delivery characteristics, and neonatal factors were examined. Statistical analysis consisted of univariate statistics, Student t test, χ 2 , and logistic regression. Results The prevalence of Occiput anterior (OA) and OP positions was 88.4% and 11.6%, respectively. The groups were similar in age, marital status, body mass index, use of epidural, frequency of inductions, episiotomies, and shoulder dystocias. The OA group had a higher frequency of rotational forceps (16.2% vs 5.9%, P =.03), greater birth weights (3304 ± 526 g vs 3092 ± 777 g, P =.004), and a larger percentage of white women (48.8% vs 34.3%, P =.04). Overall, 35% of forceps deliveries resulted in a third- or fourth-degree laceration. Anal sphincter injury occurred significantly more often in the OP group compared with the OA group (51.5% vs 32.9%, P =.003), giving an odds ratio of 2.2 (CI: 1.3-3.6). In a logistic regression model that controlled for Occiput posterior position, maternal body mass index, race, length of second stage, episiotomy, birth weight, and rotational forceps, OP head position was 3.1 (CI: 1.6-6.2) times more likely to be associated with anal sphincter injury than OA head position. Conclusion Forceps-assisted vaginal deliveries have been associated with a greater risk for anal sphincter injury. Within this population of forceps deliveries, an OP position further increases the risk of third- or fourth-degree lacerations when compared with an OA position.
