Head progression distance in prolonged second stage of labor: relationship with mode of delivery and fetal head station.
OBJECTIVE
To evaluate the clinical significance of fetal head progression distance (HPD), measured by transperineal ultrasound, during prolonged second stage of labor.


METHODS
In this prospective study, a single operator, who was blinded to the results of the digital examination, assessed using transperineal ultrasound women at ≥ 37 weeks of gestation with failure to progress in the second stage of labor. Patients had an empty urinary bladder and the examination was performed during maternal pushing. HPD was defined as the length of the line perpendicular to the infrapubic line that would connect it to the lowest part of the fetal bony skull. We analyzed associations between HPD and digital examination of fetal head station, fetomaternal characteristics, mode of delivery and perinatal outcome.


RESULTS
Sixty-five patients in prolonged second stage of labor participated in the study. The overall mean HPD was 6.50 (± 1.35; 95% CI, 6.16-6.83) cm. No correlation was found between HPD and head position or mode of delivery, but HPD was positively correlated with fetal head station and neonatal head circumference measured after delivery. Logistic regression and receiver-operating characteristics curve analysis demonstrated no significant predictive value of HPD with respect to mode of delivery.


CONCLUSIONS
Although HPD in prolonged second stage of labor could not predict mode of delivery, it may have a role as an ancillary tool for fetal head station assessment.
Chaim Sheba Medical Center, Department of Obstetrics and Gynecology, Ramat Gan, Israel, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. yinon-si@inter.net.il
Y
Y
Gilboa
Z
Z
Kivilevitch
M
M
Spira
A
A
Kedem
E
E
Katorza
O
O
Moran
R
R
Achiron
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007746:Labor Presentation; D007748:Labor Stage, Second / Q000502:physiology*; D010173:Palpation; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult