Matches in SemOpenAlex for { <https://semopenalex.org/work/W2597100025> ?p ?o ?g. }
- W2597100025 endingPage "69.e10" @default.
- W2597100025 startingPage "69.e1" @default.
- W2597100025 abstract "BackgroundSafe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions should be focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery. Prolonged attempts at vacuum delivery are associated with neonatal morbidity and maternal trauma, especially so if the procedure is unsuccessful and a cesarean is performed.ObjectiveThe aim of the study was to assess if ultrasound measurements of fetal position and station can predict duration of vacuum extractions, mode of delivery, and fetal outcome in nulliparous women with prolonged second stage of labor.Study DesignWe performed a prospective cohort study in nulliparous women at term with prolonged second stage of labor in 7 European maternity units from 2013 through 2016. Fetal head position and station were determined using transabdominal and transperineal ultrasound, respectively. Our preliminary clinical experience assessing head-perineum distance prior to vacuum delivery suggested that we should set 25 mm for the power calculation, a level corresponding roughly to +2 below the ischial spines. The main outcome was duration of vacuum extraction in relation to ultrasound measured head-perineum distance with a predefined cut-off of 25 mm, and 220 women were needed to discriminate between groups using a hazard ratio of 1.5 with 80% power and alpha 5%. Secondary outcomes were delivery mode and umbilical artery cord blood samples after birth. The time interval was evaluated using survival analyses, and the outcomes of delivery were evaluated using receiver operating characteristic curves and descriptive statistics. Results were analyzed according to intention to treat.ResultsThe study population comprised 222 women. The duration of vacuum extraction was shorter in women with head-perineum distance ≤25 mm (log rank test <0.01). The estimated median duration in women with head-perineum distance ≤25 mm was 6.0 (95% confidence interval, 5.2–6.8) minutes vs 8.0 (95% confidence interval, 7.1–8.9) minutes in women with head-perineum distance >25 mm. The head-perineum distance was associated with spontaneous delivery with area under the curve 83% (95% confidence interval, 77–89%) and associated with cesarean with area under the curve 83% (95% confidence interval, 74–92%). In women with head-perineum distance ≤35 mm, 7/181 (3.9%) were delivered by cesarean vs 9/41 (22.0%) in women with head-perineum distance >35 mm (P <.01). Ultrasound-assessed position was occiput anterior in 73%. Only 3/138 (2.2%) fetuses in occiput anterior position and head-perineum distance ≤35 mm vs 6/17 (35.3%) with nonocciput anterior position and head-perineum distance >35 mm were delivered by cesarean. Umbilical cord arterial pH <7.10 occurred in 2/144 (1.4%) women with head-perineum distance ≤35 mm compared to 8/40 (20.0%) with head-perineum distance >35 mm (P < .01).ConclusionUltrasound has the potential to predict labor outcome in women with prolonged second stage of labor. The information obtained could guide whether vacuum delivery should be attempted or if cesarean is preferable, whether senior staff should be in attendance, and if the vacuum attempt should be performed in the operating theater. Safe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions should be focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery. Prolonged attempts at vacuum delivery are associated with neonatal morbidity and maternal trauma, especially so if the procedure is unsuccessful and a cesarean is performed. The aim of the study was to assess if ultrasound measurements of fetal position and station can predict duration of vacuum extractions, mode of delivery, and fetal outcome in nulliparous women with prolonged second stage of labor. We performed a prospective cohort study in nulliparous women at term with prolonged second stage of labor in 7 European maternity units from 2013 through 2016. Fetal head position and station were determined using transabdominal and transperineal ultrasound, respectively. Our preliminary clinical experience assessing head-perineum distance prior to vacuum delivery suggested that we should set 25 mm for the power calculation, a level corresponding roughly to +2 below the ischial spines. The main outcome was duration of vacuum extraction in relation to ultrasound measured head-perineum distance with a predefined cut-off of 25 mm, and 220 women were needed to discriminate between groups using a hazard ratio of 1.5 with 80% power and alpha 5%. Secondary outcomes were delivery mode and umbilical artery cord blood samples after birth. The time interval was evaluated using survival analyses, and the outcomes of delivery were evaluated using receiver operating characteristic curves and descriptive statistics. Results were analyzed according to intention to treat. The study population comprised 222 women. The duration of vacuum extraction was shorter in women with head-perineum distance ≤25 mm (log rank test <0.01). The estimated median duration in women with head-perineum distance ≤25 mm was 6.0 (95% confidence interval, 5.2–6.8) minutes vs 8.0 (95% confidence interval, 7.1–8.9) minutes in women with head-perineum distance >25 mm. The head-perineum distance was associated with spontaneous delivery with area under the curve 83% (95% confidence interval, 77–89%) and associated with cesarean with area under the curve 83% (95% confidence interval, 74–92%). In women with head-perineum distance ≤35 mm, 7/181 (3.9%) were delivered by cesarean vs 9/41 (22.0%) in women with head-perineum distance >35 mm (P <.01). Ultrasound-assessed position was occiput anterior in 73%. Only 3/138 (2.2%) fetuses in occiput anterior position and head-perineum distance ≤35 mm vs 6/17 (35.3%) with nonocciput anterior position and head-perineum distance >35 mm were delivered by cesarean. Umbilical cord arterial pH <7.10 occurred in 2/144 (1.4%) women with head-perineum distance ≤35 mm compared to 8/40 (20.0%) with head-perineum distance >35 mm (P < .01). Ultrasound has the potential to predict labor outcome in women with prolonged second stage of labor. The information obtained could guide whether vacuum delivery should be attempted or if cesarean is preferable, whether senior staff should be in attendance, and if the vacuum attempt should be performed in the operating theater." @default.
- W2597100025 created "2017-03-23" @default.
- W2597100025 creator A5006529391 @default.
- W2597100025 creator A5014382444 @default.
- W2597100025 creator A5020573936 @default.
- W2597100025 creator A5022335169 @default.
- W2597100025 creator A5034799127 @default.
- W2597100025 creator A5053079902 @default.
- W2597100025 creator A5055662028 @default.
- W2597100025 creator A5064618382 @default.
- W2597100025 creator A5067091647 @default.
- W2597100025 creator A5074366577 @default.
- W2597100025 creator A5077726920 @default.
- W2597100025 creator A5080844951 @default.
- W2597100025 creator A5083671200 @default.
- W2597100025 creator A5088490808 @default.
- W2597100025 date "2017-07-01" @default.
- W2597100025 modified "2023-10-17" @default.
- W2597100025 title "Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study" @default.
- W2597100025 cites W1545607749 @default.
- W2597100025 cites W1718338880 @default.
- W2597100025 cites W1743901874 @default.
- W2597100025 cites W1811371672 @default.
- W2597100025 cites W1901309303 @default.
- W2597100025 cites W1967886288 @default.
- W2597100025 cites W1980462811 @default.
- W2597100025 cites W1986355026 @default.
- W2597100025 cites W1990530057 @default.
- W2597100025 cites W1998535970 @default.
- W2597100025 cites W2000937819 @default.
- W2597100025 cites W2003707315 @default.
- W2597100025 cites W2006196407 @default.
- W2597100025 cites W2023714058 @default.
- W2597100025 cites W2042569172 @default.
- W2597100025 cites W2048725876 @default.
- W2597100025 cites W2050121182 @default.
- W2597100025 cites W2052395824 @default.
- W2597100025 cites W2067138176 @default.
- W2597100025 cites W2069635991 @default.
- W2597100025 cites W2075246700 @default.
- W2597100025 cites W2088620381 @default.
- W2597100025 cites W2093678952 @default.
- W2597100025 cites W2096230879 @default.
- W2597100025 cites W2122127979 @default.
- W2597100025 cites W2123914755 @default.
- W2597100025 cites W2125165030 @default.
- W2597100025 cites W2132089139 @default.
- W2597100025 cites W2154094939 @default.
- W2597100025 cites W2161041675 @default.
- W2597100025 cites W2165610272 @default.
- W2597100025 cites W2172061782 @default.
- W2597100025 cites W2207335547 @default.
- W2597100025 cites W2261024164 @default.
- W2597100025 cites W2268003781 @default.
- W2597100025 cites W2281389683 @default.
- W2597100025 cites W2341671535 @default.
- W2597100025 cites W2344626722 @default.
- W2597100025 cites W2415088976 @default.
- W2597100025 cites W2470949189 @default.
- W2597100025 cites W2518740052 @default.
- W2597100025 cites W2530844885 @default.
- W2597100025 cites W2549372220 @default.
- W2597100025 doi "https://doi.org/10.1016/j.ajog.2017.03.009" @default.
- W2597100025 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/28327433" @default.
- W2597100025 hasPublicationYear "2017" @default.
- W2597100025 type Work @default.
- W2597100025 sameAs 2597100025 @default.
- W2597100025 citedByCount "81" @default.
- W2597100025 countsByYear W25971000252017 @default.
- W2597100025 countsByYear W25971000252018 @default.
- W2597100025 countsByYear W25971000252019 @default.
- W2597100025 countsByYear W25971000252020 @default.
- W2597100025 countsByYear W25971000252021 @default.
- W2597100025 countsByYear W25971000252022 @default.
- W2597100025 countsByYear W25971000252023 @default.
- W2597100025 crossrefType "journal-article" @default.
- W2597100025 hasAuthorship W2597100025A5006529391 @default.
- W2597100025 hasAuthorship W2597100025A5014382444 @default.
- W2597100025 hasAuthorship W2597100025A5020573936 @default.
- W2597100025 hasAuthorship W2597100025A5022335169 @default.
- W2597100025 hasAuthorship W2597100025A5034799127 @default.
- W2597100025 hasAuthorship W2597100025A5053079902 @default.
- W2597100025 hasAuthorship W2597100025A5055662028 @default.
- W2597100025 hasAuthorship W2597100025A5064618382 @default.
- W2597100025 hasAuthorship W2597100025A5067091647 @default.
- W2597100025 hasAuthorship W2597100025A5074366577 @default.
- W2597100025 hasAuthorship W2597100025A5077726920 @default.
- W2597100025 hasAuthorship W2597100025A5080844951 @default.
- W2597100025 hasAuthorship W2597100025A5083671200 @default.
- W2597100025 hasAuthorship W2597100025A5088490808 @default.
- W2597100025 hasBestOaLocation W25971000251 @default.
- W2597100025 hasConcept C126322002 @default.
- W2597100025 hasConcept C131872663 @default.
- W2597100025 hasConcept C141071460 @default.
- W2597100025 hasConcept C144237770 @default.
- W2597100025 hasConcept C148220186 @default.
- W2597100025 hasConcept C188816634 @default.
- W2597100025 hasConcept C201903717 @default.