Aktif doğum eylemi sırasında transperineal ve transabdominal ultrason bulgularının spontan vajinal doğumu öngörmedeki etkinliği

Abstract

Amaç: Bu araştırmada, aktif doğum eylemi sırasında transperineal ve transabdominal ultrason ölçümlerinin, özellikle ilerleme açısı (AoP), baş-perineum mesafesi (HPD) ve orta hat açısının (MLA), doğum şekli ile ilişkisini değerlendirmek amaçlandı. Yöntemler: Bu prospektif gözlemsel çalışmaya aktif doğum eyleminde olan gebeler dahil edildi ve tekrarlayan transperineal ve transabdominal ultrason muayeneleri yapıldı. Saatlik AoP, HPD ve MLA ölçümleri kaydedildi. Hastalar doğum şekline göre (spontan vajinal doğum veya sezaryen) sınıflandırıldı ve ultrason parametrelerindeki değişiklikler gruplar arasında karşılaştırıldı. Ayrıca nullipar ve multipar kadınlar ayrı olarak analiz edildi. Bulgular: Vajinal doğum grubunda ortalama AoP değerleri tüm zaman noktalarında sezaryen grubuna kıyasla anlamlı derecede daha yüksekti (p<0.001). HPD ölçümleri ise sezaryen grubunda ilk saatten itibaren anlamlı derecede yüksek bulundu (p≤0.001). Multipar kadınların aktif doğum boyunca nulliparlara kıyasla sürekli olarak daha yüksek AoP değerlerine sahip olduğu görüldü (p<0.01) ve bu fark ikinci evrenin başlangıcında da devam etti. Analizler, aktif doğum başlangıcındaki düşük AoP değerlerinin daha uzun doğum süresiyle anlamlı şekilde ilişkili olduğunu ortaya koydu (negatif korelasyon). İlk saatlerde sezaryen grubunda daha yüksek MLA değerleri gözlendi (p<0.001). Sonuç: AoP, HPD ve MLA’nın doğum eylemi boyunca seri ultrason ölçümleri, doğum şeklini öngörmede objektif ve güvenilir bilgiler sağlamaktadır. Daha yüksek AoP değerleri vajinal doğumla ilişkili iken, artmış HPD ve MLA değerleri sezaryen ile ilişkilidir. Özellikle, erken doğum eyleminde AoP’nin <100° olması sezaryen için güçlü bir öngörücü olabilir. Bu parametrelerin rutin kullanımı doğum yönetiminde klinisyenlere daha doğru kararlar vermede yardımcı olabilir.

Keywords

• Fetal Baş
• Doğum Obstetrik
• Ultrasonografi, Prenatal

Supporting Institution

Herhangi bir enstütü ve organizasyondan destek alınmamıştır.

Ethical Statement

Bu çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Çalışma için Adana Şehir Eğitim ve Araştırma Hastanesi Etik Kurulu’ndan onay alınmıştır (Karar No: 76, Tarih: 25.07.2024). Tüm katılımcılardan çalışmaya dahil edilmeden önce yazılı aydınlatılmış onam alınmıştır.

Thanks

Teşekkür edilecek ek bir kişi/kuruluş bulunmamaktadır.

The efficacy of transperineal and transabdominal ultrasound findings in predicting spontaneous vaginal delivery during active labor

Abstract

Aims: This research sought to assess the clinical value of transperineal and transabdominal ultrasound measurements, particularly angle of progression (AoP), head-perineum distance (HPD), and midline angle (MLA), in relation to mode of delivery during the active phase of labor. Methods: In this prospective observational design, pregnant women in active labor were enrolled and underwent repeated transperineal and transabdominal ultrasound examinations. Hourly AoP, HPD and MLA measurements were performed. Patients were classified according to delivery mode (spontaneous vaginal birth or cesarean section) and the changes in ultrasound parameters were compared between groups. Multiparous and nulliparous women were also analyzed separately. Results: Mean AoP values remained significantly greater in the vaginal delivery group throughout all time points when compared to the cesarean group (p<0.001). HPD measurements were significantly increased in the cesarean group beginning as early as the first hour (p≤0.001). Multiparous women had consistently higher AoP values than nulliparous women throughout active labor (p<0.01), with the difference persisting at the onset of the second stage. Analysis revealed that smaller AoP values at the onset of active labor were significantly related to longer labor courses, confirming a negative correlation. Higher MLA meauserments were observed in the cesarean group within the first hours of labor (p<0.001). Conclusion: Serial measurements of AoP, HPD and MLA by ultrasound provide objective and reliable information for predicting delivery mode in active labor. By integrating these ultrasound findings into practice, clinicians may be able to make better decisions and manage labor more efficiently

Keywords

• Fetal head
• labor
• obstetric
• ultrasonography
• prenatal

Supporting Institution

No financial support was received from any institution or organization for this study.

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki. Approval was obtained from the Ethics Committee of Adana City Training and Research Hospital (Decision No: 76, Date: 25.07.2024). Written informed consent was obtained from all participants prior to enrollment.

Thanks

No additional acknowledgments

References

1. Uwamariya J, Abayisenga G, Ndizeye N, et al. Effect of active follow-up of women with previous cesarean delivery on uptake of timely safe obstetric and surgical care: comparison between pre-intervention and intervention cohorts in Rwanda. PLoS One. 2025;20(6):e0325884. doi:10.1371/journal.pone.0325884
2. Pinton A, Severac F, Meyer N, et al. A comparison of vaginal ultrasound and digital examination in predicting preterm delivery in women with threatened preterm labor: a cohort study. Acta Obstet Gynecol Scand. 2017;96(4):447-453. doi:10.1111/aogs.13071
3. Haumonte JB, Blanc J, Castel P, et al. Uncertain fetal head engagement: a prospective randomized controlled trial comparing digital exam with angle of progression. Am J Obstet Gynecol. 2022;227(4):625.e1-625.e8. doi:10.1016/j.ajog.2022.04.018
4. Nebel S, Vardon D, Dreyfus M, Pizzoferrato AC. 2D-transperineal ultrasound in delivery room: contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review. J Gynecol Obstet Hum Reprod. 2025;54(3):102910. doi:10.1016/j.jogoh.2025.102910
5. Usman S, Hanidu A, Kovalenko M, Hassan WA, Lees C. The sonopartogram. Am J Obstet Gynecol. 2023;228(5s):S997-s1016. doi:10. 1016/j.ajog.2022.06.027
6. Conversano F, Di Trani MG, Morello R, et al. Automated approach for enhancing fetal head station assessment in labor with transperineal ultrasound. Ultrasound Med Biol. 2025;51(1):180-187. doi:10.1016/j.ultrasmedbio.2024.09.022
7. Wong KW, Sultan AH, Andrews V, Allen-Coward H, Thakar R. Does the fetal head station and position affect the pelvic floor muscles in labour? A prospective study using 3 dimensional transperineal ultrasound. Eur J Obstet Gynecol Reprod Biol. 2025;313:114577. doi:10.1016/j.ejogrb. 2025.114577
8. Kartal Gölcük E, Dincgez B, Ozgen G, Ustunyurt E. The predictive role of serial transperineal sonography during the first stage of labor for cesarean section. J Perinat Med. 2025;53(2):132-139. doi:10.1515/jpm-2024-0450

9. Ghi T, Eggebø T, Lees C, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstetr Gynecol. 2018;52(1):128-139.
10. Bulut AN, Ceyhan V. Evaluation of the labour process with serial transperineal ultrasonography and prediction of the type of birth. J Perinat Med. 2020;49(1):36-42. doi:10.1515/jpm-2020-0323
11. Chan VYT, Lau WL, So MKP, Leung WC. Measuring angle of progression by transperineal ultrasonography to predict successful instrumental and cesarean deliveries during prolonged second stage of labor. Int J Gynaecol Obstet. 2019;144(2):192-198. doi:10.1002/ijgo.12712
12. Hans R, Reddy D, Shetty J. Serial intrapartum ultrasound to predict vaginal delivery using angle of progression and head- progression distance in term nulliparous women. Eur J Obstet Gynecol Reprod Biol. 2025;305:125-131. doi:10.1016/j.ejogrb.2024.12.014
13. Katzir T, Brezinov Y, Khairish E, Hadad S, Vaisbuch E, Levy R. Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor. Arch Gynecol Obstet. 2023;307(3):763-770. doi:10.1007/s00404-022-06469-5
14. Nassr AA, Berghella V, Hessami K, 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):205-214.e2. doi:10.1016/j.ajog.2021.07.031
15. 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. doi:10.5468/ogs.23141
16. Carvalho Neto RH, Viana Junior AB, Moron AF, Araujo Júnior E, Carvalho FHC, Feitosa HN. Assessment of the angle of progression and distance perineum-head in the prediction of type of delivery and duration of labor using intrapartum ultrasonography. J Matern Fetal Neonatal Med. 2021;34(14):2340-2348. doi:10.1080/14767058.2019.1666818
17. Tse WT, Chaemsaithong P, Chan WWY, et al. Labor progress determined by ultrasound is different in women requiring cesarean delivery from those who experience a vaginal delivery following induction ofmlabor. Am J Obstet Gynecol. 2019;221(4):335.e1-335.e18. doi:10.1016/j.ajog.2019.05.040
18. Sainz JA, Borrero C, Aquise A, Serrano R, Gutiérrez L, Fernández-Palacín A. Utility of intrapartum transperineal ultrasound to predict cases of failure in vacuum extraction attempt and need of cesarean section to complete delivery. J Matern Fetal Neonatal Med. 2016;29(8): 1348-1352. doi:10.3109/14767058.2015.1048680
19. Dall’Asta A, Angeli L, Masturzo B, et al. Prediction of spontaneous vaginal delivery in nulliparous women with a prolonged second stage of labor: the value of intrapartum ultrasound. Am J Obstet Gynecol. 2019;221(6):642.e1-642.e13. doi:10.1016/j.ajog.2019.09.045
20. Skinner SM, Giles-Clark HJ, Higgins C, Mol BW, Rolnik DL. Prognostic accuracy of ultrasound measures of fetal head descent to predict outcome of operative vaginal birth: a comparative systematic review and meta-analysis. Am J Obstet Gynecol. 2023;229(1):10-22.e10. doi:10.1016/ j.ajog.2022.11.1294