European journal of obstetrics, gynecology, and reproductive biology · 2025
Fetal head position matters: Association with ultrasound-measured head-perineum distance prior to operative vaginal delivery.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Merlier Margaux, Ghesquière Louise, Ramdane Nassima, Behal Hélène, Drumez Elodie, Berveiller Paul, Garabedian Charles
Аннотация
OBJECTIVE: Identifying fetal station before operative vaginal delivery (OVD) remains a clinical challenge. Ultrasound evaluation of the head-perineum distance (HPD) is increasingly used as a tool to predict operative delivery success or failure. However, this approach does not account for fetal head position, the mechanistic characteristics of which affect fetal descent into the pelvis and could therefore affect ultrasound measurement. Objective of this study was to evaluate the association of fetal head position with ultrasound-measured HPD before OVD, according to clinical levels of station.
METHODS: A retrospective cross-sectional study conducted from February 2019 to May 2020 in two French tertiary hospitals. Women with singleton pregnancies of ≥34 weeks' gestation and cephalic position who had a successful OVD were included. Fetal head position was determined ultrasonographically. Station was assessed clinically and ultrasonographically (HPD).
RESULTS: 1036 OVD cases that had HPD measurements were reported. Vacuum-assisted delivery was performed in 65 % of cases, and use of forceps or spatula were reported in 35 % of cases. Fetal head position was anterior in 812 cases (78.0 %), transverse in 88 (9.0 %) and posterior in 136 (13.0 %). HPD measurement was significantly shorter in the anterior position group (37.7 mm ± 11.6) compared with the transverse (46.53 ± 12.3) and posterior (45.5 ± 11.4) groups (p < 0.001). This difference persisted after the results were stratified according to clinically identified station.
CONCLUSION: At the same clinically identified stations, HPD measurement is influenced by fetal head position. This report highlights the importance of taking fetal head position into account when measuring HPD prior to OVD, and further studies evaluating ultrasound thresholds predictive of HPD for successful or unsuccessful operative delivery based on fetal head position are needed.
METHODS: A retrospective cross-sectional study conducted from February 2019 to May 2020 in two French tertiary hospitals. Women with singleton pregnancies of ≥34 weeks' gestation and cephalic position who had a successful OVD were included. Fetal head position was determined ultrasonographically. Station was assessed clinically and ultrasonographically (HPD).
RESULTS: 1036 OVD cases that had HPD measurements were reported. Vacuum-assisted delivery was performed in 65 % of cases, and use of forceps or spatula were reported in 35 % of cases. Fetal head position was anterior in 812 cases (78.0 %), transverse in 88 (9.0 %) and posterior in 136 (13.0 %). HPD measurement was significantly shorter in the anterior position group (37.7 mm ± 11.6) compared with the transverse (46.53 ± 12.3) and posterior (45.5 ± 11.4) groups (p < 0.001). This difference persisted after the results were stratified according to clinically identified station.
CONCLUSION: At the same clinically identified stations, HPD measurement is influenced by fetal head position. This report highlights the importance of taking fetal head position into account when measuring HPD prior to OVD, and further studies evaluating ultrasound thresholds predictive of HPD for successful or unsuccessful operative delivery based on fetal head position are needed.