title: [Correlation between the perineal-to-skull measurement by tranperineal ultrasound, failure of vaginal operative delivery and maternal-fetal morbidity].
abstract: OBJECTIVE
  To assess the influence of the perineal-to-skull measurement by tranperineal ultrasound (TPU) on the outcome of vaginal operative extraction together with maternal and fetal morbidity.
  
  
  METHODS
  Retrospective, monocentric and descriptive study was done on 272 patients, from 2009 January 1st to 2009 December 31st. It compares the failure rate of instrumental extraction, total caesarean section rate together with the maternal morbidity (type of perineal tears and post-partum hemorrhage rate) and fetal morbidity (5' Apgar score, arterial pH, transfer in neonatal intensive care unit) to the values obtained with TPU.
  
  
  RESULTS
  There is a correlation between the perineal-to-skull measurements higher or equal to 50mm at TPU and the instrumental failure rate (<50mm 0.8% vs. ≥50mm 11.9%; P<0.0001), caesarean (0.9% vs. 33.3%; P<0.0001), post-partum haemorrhage (3% vs. 11.9%; P=0.02), et paediatric intervention (16.7% vs. 31%; P=0.03).
  
  
  CONCLUSIONS
  Perineal-to-skull distance measured with TPU higher or equal to 50mm is at risk of instrumental failure and maternal morbidity. Associated with clinical examination and usual obstetrical risk factors, TPU could be useful to the decision between operative vaginal delivery and prophylactic caesarean section.
authors: Service de gynécologie-obstétrique, CHU de Dijon, 2, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France. Electronic address: flo_rine@mac.com.
authors: F
authors: F
authors: Tabard
authors: C
authors: C
authors: Feyeux
authors: C
authors: C
authors: Peyronel
authors: T
authors: T
authors: Rousseau
authors: J
authors: J
authors: Cottenet
authors: P
authors: P
authors: Sagot
authors: G
authors: G
authors: Macé
mesh_terms: D000328:Adult; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015931:Intensive Care, Neonatal; D009017:Morbidity; D010502:Perineum / Q000000981:diagnostic imaging* / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012886:Skull / Q000000981:diagnostic imaging* / Q000196:embryology*; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Extraction instrumentale; Fetal morbidity; Instrumental delivery; Maternal morbidity; Morbidité maternelle; Morbidité néonatale; Transperineal ultrasound; Échographie transpérinéale