Doğum Şeklini Belirlemede İntrapartum Transperineal Ultrasonografinin Tahmin Değeri: Prospektif Bir Çalışma
Öz
Amaç: Bu çalışmanın amacı, intrapartum transperineal ultrasonografi (ITU) parametrelerinin doğum şeklini öngörmedeki etkinliğini değerlendirmektir.
Yöntem: Bu prospektif çalışmaya, Nisan 2023 ile Nisan 2024 tarihleri arasında Düzce Üniversitesi Sağlık Uygulama ve Araştırma Merkezi'nde, aktif doğum eylemi içinde ve membranları rüptüre olmuş 104 gebe dahil edilmiştir. ITU ile ilerleme açısı (AoP), baş-perine mesafesi (HPD) ve orta hat açısı (MLA) ölçümleri yapıldı. Bu parametreler, dijital vajinal muayene bulguları ve doğum sonuçları ile karşılaştırıldı.
Bulgular: Katılımcıların 93’ü (%89,4) spontan vajinal doğum (SVD), 6’sı (%5,7) operatif vajinal doğum (OVD) ve 5’i (%4,8) sezaryen (C/S) ile doğum yaptı. AoP1 ve AoP2 değerleri, SVD grubunda OVD ve C/S gruplarına kıyasla anlamlı derecede yüksekti (p<0,001). ΔAoP değeri OVD grubunda anlamlı derecede düşük bulundu (p=0,044). HPD1 ve HPD2 ölçümleri C/S grubunda anlamlı olarak daha yüksekti (sırasıyla p=0,031 ve p=0,041). MLA1 ve MLA2 değerleri ise SVD grubunda anlamlı derecede daha düşüktü (sırasıyla p=0,002 ve p=0,001).
Sonuç: ITU, doğum şeklini öngörmede değerli bir araçtır. AoP, HPD ve MLA ölçümleri, doğum yönetiminde klinisyenlere yardımcı olabilecek objektif ve güvenilir veriler sağlamaktadır. Bu bulguların doğrulanması ve klinik kullanıma yönelik standart protokollerin oluşturulması için daha büyük örneklem gruplarıyla ek çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
İntrapartum transperineal ultrasonografi doğum şeklini tahmin ilerleme açısı baş-perine mesafesi
Kaynakça
- 1. Kissler K, Hurt KJ. The Pathophysiology of Labor Dystocia: Theme with Variations. Reprod Sci. 2023;30(3):729-42.
- 2. Cornthwaite K, Draycott T, Winter C, Lenguerrand E, Hewitt P, Bahl R. Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study. Acta Obstet Gynecol Scand. 2023;102(1):43-50.
- 3. Hadad S, Oberman M, Ben-Arie A, Sacagiu M, Vaisbuch E, Levy R. Intrapartum ultrasound at the initiation of the active second stage of labor predicts spontaneous vaginal delivery. Am J Obstet Gynecol MFM. 2021;3(1):100249.
- 4. Mohaghegh Z, Jahanfar S, Abedi P, El Aziz MAA. Reliability of ultrasound versus digital vaginal examination in detecting cervical dilatation during labor: a diagnostic test accuracy systematic review. Ultrasound J. 2021;13(1):37.
- 5. Dimassi K, Hammami A. Agreement between digital vaginal examination and intrapartum ultrasound for labour monitoring. J Obstet Gynaecol. 2022;42(5):981-8.
- 6. Nguyen MT, Ouzounian JG. Evaluation and Management of Fetal Macrosomia. Obstet Gynecol Clin North Am. 2021;48(2):387-99.
- 7. Seidl-Mlczoch E, Kasprian G, Ba-Ssalamah A, Stuempflen M, Kitzmueller E, Muin DA, et al. Characterization of phenotypic spectrum of fetal heterotaxy syndrome by combining ultrasound and magnetic resonance imaging. Ultrasound Obstet Gynecol. 2021;58(6):837-45.
- 8. Shalabna E, Kedar R, Assaf W, Nahshon C, Kugelman N, Lavie O, et al. The association between obesity and the success of trial of labor after cesarean delivery (TOLAC) in women with past vaginal delivery. J Perinat Med. 2024;52(2):158-64.
- 9. Recker F, Weber E, Strizek B, Gembruch U, Westerway SC, Dietrich CF. Point-of-care ultrasound in obstetrics and gynecology. Arch Gynecol Obstet. 2021;303(4):871-6.
- 10. Malvasi A, Montanari Vergallo G, Tinelli A, Marinelli E. "Can the intrapartum ultrasonography reduce the legal liability in distocic labor and delivery?". J Matern Fetal Neonatal Med. 2018;31(8):1108-9.
- 11. Baska-Vincze B, Baska F, Szenci O. Transabdominal ultrasonographic evaluation of fetal well-being in the late-term mare and cow. Acta Vet Hung. 2014;62(4):439-51.
- 12. Alhafez L, Berghella V. Evidence-based labor management: first stage of labor (part 3). Am J Obstet Gynecol MFM. 2020;2(4):100185.
- 13. Wiafe YA, Whitehead B, Venables H, Nakua EK. The effectiveness of intrapartum ultrasonography in assessing cervical dilatation, head station and position: A systematic review and meta-analysis. Ultrasound. 2016;24(4):222-32.
- 14. Malvasi A, Vinciguerra M, Lamanna B, Cascardi E, Damiani GR, Muzzupapa G, et al. Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review. Diagnostics (Basel). 2022;12(12).
- 15. Bastiaansen WAP, Klein S, Koning AHJ, Niessen WJ, Steegers-Theunissen RPM, Rousian M. Computational methods for the analysis of early-pregnancy brain ultrasonography: a systematic review. EBioMedicine. 2023;89:104466.
- 16. Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol. 2018;52(1):128-39.
- 17. Chan VYT, Lau WL. Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery. Am J Obstet Gynecol MFM. 2021;3(6s):100439.
- 18. Jung JE, Lee YJ. Intrapartum transperineal ultrasound: angle of progression to evaluate and predict the mode of delivery and labor progression. Obstet Gynecol Sci. 2024;67(1):1-16.
- 19. Nassr AA, Berghella V, Hessami K, Bibbo C, Bellussi F, Robinson JN, et al. Intrapartum ultrasound measurement of angle of progression at the onset of the second stage of labor for prediction of spontaneous vaginal delivery in term singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022;226(2):205-14.e2.
- 20. Gimovsky AC, Berghella V. Evidence-based labor management: second stage of labor (part 4). Am J Obstet Gynecol MFM. 2022;4(2):100548.
- 21. Arthuis CJ, Perrotin F, Patat F, Brunereau L, Simon EG. Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound. Ultrasound Obstet Gynecol. 2016;48(6):779-85.
- 22. Malvasi A, Malgieri LE, Cicinelli E, Vimercati A, D'Amato A, Dellino M, et al. Artificial Intelligence, Intrapartum Ultrasound and Dystocic Delivery: AIDA (Artificial Intelligence Dystocia Algorithm), a Promising Helping Decision Support System. J Imaging. 2024;10(5).
Predictive Value of Intrapartum Transperineal Ultrasonography in Determining Delivery Mode: A Prospective Study
Öz
Objective: This study aimed to evaluate the usefulness of intrapartum transperineal ultrasonographic (ITU) parameters in predicting delivery mode.
Methods: This prospective study included 104 pregnant women in active labor with ruptured membranes at Düzce University Health Application and Research Center from April 2023 to April 2024. ITU measured the angle of progression (AoP), head-perineum distance (HPD), and midline angle (MLA). These parameters were compared with digital vaginal examinations and delivery outcomes.
Results: Of the participants, 93 (89.4%) had spontaneous vaginal deliveries (SVD), 6 (5.7%) had operative vaginal deliveries (OVD), and 5 (4.8%) had cesarean sections (C/S). AoP1 and AoP2 were significantly higher in the SVD group compared to OVD and C/S groups (p<0.001). The ΔAoP was significantly lower in the OVD group (p=0.044). HPD1 and HPD2 were significantly higher in the C/S group (p=0.031 and p=0.041, respectively). MLA1 and MLA2 were significantly lower in the SVD group (p=0.002 and p=0.001, respectively).
Conclusion: ITU is a valuable tool in predicting delivery mode. AoP, HPD, and MLA measurements provide objective and reliable data to assist clinicians in labor management. Further research with larger sample sizes is needed to validate these findings and establish standardized protocols for clinical use.
Anahtar Kelimeler
Intrapartum transperineal ultrasound Predicting delivery mode Angle of progression Head-perineum distance
Kaynakça
- 1. Kissler K, Hurt KJ. The Pathophysiology of Labor Dystocia: Theme with Variations. Reprod Sci. 2023;30(3):729-42.
- 2. Cornthwaite K, Draycott T, Winter C, Lenguerrand E, Hewitt P, Bahl R. Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study. Acta Obstet Gynecol Scand. 2023;102(1):43-50.
- 3. Hadad S, Oberman M, Ben-Arie A, Sacagiu M, Vaisbuch E, Levy R. Intrapartum ultrasound at the initiation of the active second stage of labor predicts spontaneous vaginal delivery. Am J Obstet Gynecol MFM. 2021;3(1):100249.
- 4. Mohaghegh Z, Jahanfar S, Abedi P, El Aziz MAA. Reliability of ultrasound versus digital vaginal examination in detecting cervical dilatation during labor: a diagnostic test accuracy systematic review. Ultrasound J. 2021;13(1):37.
- 5. Dimassi K, Hammami A. Agreement between digital vaginal examination and intrapartum ultrasound for labour monitoring. J Obstet Gynaecol. 2022;42(5):981-8.
- 6. Nguyen MT, Ouzounian JG. Evaluation and Management of Fetal Macrosomia. Obstet Gynecol Clin North Am. 2021;48(2):387-99.
- 7. Seidl-Mlczoch E, Kasprian G, Ba-Ssalamah A, Stuempflen M, Kitzmueller E, Muin DA, et al. Characterization of phenotypic spectrum of fetal heterotaxy syndrome by combining ultrasound and magnetic resonance imaging. Ultrasound Obstet Gynecol. 2021;58(6):837-45.
- 8. Shalabna E, Kedar R, Assaf W, Nahshon C, Kugelman N, Lavie O, et al. The association between obesity and the success of trial of labor after cesarean delivery (TOLAC) in women with past vaginal delivery. J Perinat Med. 2024;52(2):158-64.
- 9. Recker F, Weber E, Strizek B, Gembruch U, Westerway SC, Dietrich CF. Point-of-care ultrasound in obstetrics and gynecology. Arch Gynecol Obstet. 2021;303(4):871-6.
- 10. Malvasi A, Montanari Vergallo G, Tinelli A, Marinelli E. "Can the intrapartum ultrasonography reduce the legal liability in distocic labor and delivery?". J Matern Fetal Neonatal Med. 2018;31(8):1108-9.
- 11. Baska-Vincze B, Baska F, Szenci O. Transabdominal ultrasonographic evaluation of fetal well-being in the late-term mare and cow. Acta Vet Hung. 2014;62(4):439-51.
- 12. Alhafez L, Berghella V. Evidence-based labor management: first stage of labor (part 3). Am J Obstet Gynecol MFM. 2020;2(4):100185.
- 13. Wiafe YA, Whitehead B, Venables H, Nakua EK. The effectiveness of intrapartum ultrasonography in assessing cervical dilatation, head station and position: A systematic review and meta-analysis. Ultrasound. 2016;24(4):222-32.
- 14. Malvasi A, Vinciguerra M, Lamanna B, Cascardi E, Damiani GR, Muzzupapa G, et al. Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review. Diagnostics (Basel). 2022;12(12).
- 15. Bastiaansen WAP, Klein S, Koning AHJ, Niessen WJ, Steegers-Theunissen RPM, Rousian M. Computational methods for the analysis of early-pregnancy brain ultrasonography: a systematic review. EBioMedicine. 2023;89:104466.
- 16. Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol. 2018;52(1):128-39.
- 17. Chan VYT, Lau WL. Intrapartum ultrasound and the choice between assisted vaginal and cesarean delivery. Am J Obstet Gynecol MFM. 2021;3(6s):100439.
- 18. Jung JE, Lee YJ. Intrapartum transperineal ultrasound: angle of progression to evaluate and predict the mode of delivery and labor progression. Obstet Gynecol Sci. 2024;67(1):1-16.
- 19. Nassr AA, Berghella V, Hessami K, Bibbo C, Bellussi F, Robinson JN, et al. Intrapartum ultrasound measurement of angle of progression at the onset of the second stage of labor for prediction of spontaneous vaginal delivery in term singleton pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022;226(2):205-14.e2.
- 20. Gimovsky AC, Berghella V. Evidence-based labor management: second stage of labor (part 4). Am J Obstet Gynecol MFM. 2022;4(2):100548.
- 21. Arthuis CJ, Perrotin F, Patat F, Brunereau L, Simon EG. Computed tomographic study of anatomical relationship between pubic symphysis and ischial spines to improve interpretation of intrapartum translabial ultrasound. Ultrasound Obstet Gynecol. 2016;48(6):779-85.
- 22. Malvasi A, Malgieri LE, Cicinelli E, Vimercati A, D'Amato A, Dellino M, et al. Artificial Intelligence, Intrapartum Ultrasound and Dystocic Delivery: AIDA (Artificial Intelligence Dystocia Algorithm), a Promising Helping Decision Support System. J Imaging. 2024;10(5).
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Hizmetleri ve Sistemleri (Diğer) |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 17 Haziran 2025 |
| Gönderilme Tarihi | 3 Şubat 2025 |
| Kabul Tarihi | 11 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 17 Sayı: 2 |
