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Head-to-perineum distance measured transperineally as a predictor of failed midcavity vacuum-assisted delivery

  • Camille Nallet
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
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  • Ruben Ramirez Zegarra
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi)
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  • Sylvia Mazellier
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
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  • Andrea Dall'asta
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi)
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  • Marc Puyraveau
    Affiliations
    Clinical Methodology Center, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Mr Puyraveau)
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  • Marine Lallemant
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
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  • Rajeev Ramanah
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)

    Nanomedecine Laboratory, Imaging, and Therapeutics, INSERM EA 4662, University of Franche-Comté, Besançon, France (Drs Ramanah, and Mottet)
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  • Didier Riethmuller
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)

    Department of Obstetrics and Gynaecology, University Hospital of Grenoble, University of Grenoble Alpes, Grenoble, France. (Dr Riethmuller)
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  • Tullio Ghi
    Correspondence
    Corresponding author: Tullio Ghi, MD, PhD.
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi)
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  • Nicolas Mottet
    Affiliations
    Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)

    Nanomedecine Laboratory, Imaging, and Therapeutics, INSERM EA 4662, University of Franche-Comté, Besançon, France (Drs Ramanah, and Mottet)
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Published:November 30, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100827

      BACKGROUND

      During the second stage of labor, in case of a need for a fetal extraction at midcavity, the choice of attempting the procedure between operative vaginal delivery and cesarean delivery is difficult. Moreover, guidelines on this subject are not clear.

      OBJECTIVE

      This study aimed to identify antenatal and intrapartum parameters associated with a failed midcavity vacuum-assisted delivery and its association with maternal and neonatal adverse outcomes.

      STUDY DESIGN

      This was a single-center, retrospective, cohort study conducted at a tertiary maternity hospital in France from January 2010 to December 2020. Women with singleton pregnancies under epidural analgesia with nonanomalous cephalic presenting fetuses and gestational ages at ≥37 weeks of gestation, who were submitted to midcavity vacuum-assisted delivery, were included. Following the American College of Obstetricians and Gynecologists definition, midcavity was defined as the presenting part of the fetus (ie, the fetal head) found at stations 0 and +1. For research purposes, all patients were submitted to transperineal ultrasound to evaluate the head-to-perineum distance, however, this measurement did not affect the decision to perform a midcavity vacuum-assisted delivery. The primary outcome of the study was failed midcavity vacuum-assisted delivery leading to cesarean delivery or the use of a different instrument to achieve vaginal delivery.

      RESULTS

      Overall, 951 cases of midcavity vacuum-assisted delivery were included in this study. Failed midcavity vacuum-assisted delivery occurred in 242 patients (25.4%). Factors independently associated with failed midcavity vacuum-assisted delivery included maternal height (adjusted odds ratio, 0.96; 95% confidence interval, 0.94–0.99; P=.002), duration of the active phase of the first stage of labor (adjusted odds ratio, 1.11; 95% confidence interval, 1.05–1.17; P<.001), nonocciput anterior fetal head position (adjusted odds ratio, 1.47; 95% confidence interval, 1.06–2.04; P=.02), z score of the head-to-perineum distance (adjusted odds ratio, 1.23; 95% confidence interval, 1.05–1.43; P=.01), and birthweight of >4000 g (adjusted odds ratio, 2.04; 95% confidence interval, 1.28–3.26; P=.003). Women submitted to a failed midcavity vacuum-assisted delivery were more likely to have a major postpartum hemorrhage (7.1% vs 2.0%; P<.001), whereas neonates were more likely to have an umbilical artery pH of <7.1 (30.5% vs 19.8%; P=.001), be admitted to the neonatal intensive care unit (9.6% vs 4.7%; P=.005), and have a severe caput succedaneum (14.9% vs 0.7%; P<.001). Subgroup analysis on all patients with a fetal head station of 0 found that the head-to-perineum distance was the only independent variable associated with failed midcavity vacuum-assisted delivery (adjusted odds ratio, 1.66; 95% confidence interval, 1.29–2.12; P<.001). The area under the receiving operating characteristic curve of the head-to-perineum distance in this subgroup population was 0.67 (95% confidence interval, 0.60–0.73; P<.001), and the optimal cutoff point of the head-to-perineum distance measurement discriminating between failed and successful midcavity vacuum-assisted deliveries was 55 mm. It was associated with a 0.90 (95% confidence interval, 0.83–0.95) sensitivity, 0.19 (95% confidence interval, 0.14–0.25) specificity, 0.36 (95% confidence interval, 0.30–0.42) positive predictive value, and 0.80 (95% confidence interval, 0.66–0.90) negative predictive value.

      CONCLUSION

      Study data showed that a high fetal head station, measured using the head-to-perineum distance, and a nonocciput anterior position of the fetal head are independently associated with failed midcavity vacuum-assisted delivery. The result supported the systematic assessment of the sonographic head station and position before performing a midcavity vacuum-assisted delivery.

      Keywords

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      References

        • Alexander JM
        • Leveno KJ
        • Rouse DJ
        • et al.
        Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor.
        Obstet Gynecol. 2007; 109: 917-921
        • Lurie S
        • Raz N
        • Boaz M
        • Sadan O
        • Golan A.
        Comparison of maternal outcomes from primary cesarean section during the second compared with first stage of labor by indication for the operation.
        Eur J Obstet Gynecol Reprod Biol. 2014; 182: 43-47
      1. Operative vaginal birth: ACOG Practice Bulletin, Number 219.
        Obstet Gynecol. 2020; 135: e149-e159
        • Murphy DJ
        • Strachan BK
        • Bahl R
        Royal College of Obstetricians and Gynaecologists. Assisted vaginal birth: Green-top Guideline No. 26.
        BJOG. 2020; 127: e70-e112
        • Vayssière C
        • Beucher G
        • Dupuis O
        • et al.
        Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.
        Eur J Obstet Gynecol Reprod Biol. 2011; 159: 43-48
        • Muraca GM
        • Sabr Y
        • Lisonkova S
        • et al.
        Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station.
        CMAJ. 2017; 189: E764-E772
        • Ducarme G
        • Hamel JF
        • Bouet PE
        • Legendre G
        • Vandenbroucke L
        • Sentilhes L.
        Maternal and neonatal morbidity after attempted operative vaginal delivery according to fetal head station.
        Obstet Gynecol. 2015; 126: 521-529
        • Muraca GM
        • Skoll A
        • Lisonkova S
        • et al.
        Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery.
        BJOG. 2018; 125: 693-702
        • Murphy DJ
        • Liebling RE
        • Verity L
        • Swingler R
        • Patel R.
        Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study.
        Lancet. 2001; 358: 1203-1207
        • Gardella C
        • Taylor M
        • Benedetti T
        • Hitti J
        • Critchlow C.
        The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes.
        Am J Obstet Gynecol. 2001; 185: 896-902
        • Murphy DJ
        • Macleod M
        • Bahl R
        • Strachan B.
        A cohort study of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery.
        Eur J Obstet Gynecol Reprod Biol. 2011; 156: 41-45
        • Cunningham F
        • Leveno KJ
        • Bloom SL
        • et al.
        Operative vaginal delivery.
        Williams obstetrics. 25th ed. McGraw-Hill Education, New York, NY2018
        • Verhoeven CJ
        • Nuij C
        • Janssen-Rolf CR
        • et al.
        Predictors for failure of vacuum-assisted vaginal delivery: a case-control study.
        Eur J Obstet Gynecol Reprod Biol. 2016; 200: 29-34
        • Palatnik A
        • Grobman WA
        • Hellendag MG
        • Janetos TM
        • Gossett DR
        • Miller ES.
        Predictors of failed operative vaginal delivery in a contemporary obstetric cohort.
        Obstet Gynecol. 2016; 127: 501-506
        • Ramphul M
        • Kennelly MM
        • Burke G
        • Murphy DJ.
        Risk factors and morbidity associated with suboptimal instrument placement at instrumental delivery: observational study nested within the instrumental delivery & ultrasound randomised controlled trial ISRCTN 72230496.
        BJOG. 2015; 122: 558-563
        • Ben-Haroush A
        • Melamed N
        • Kaplan B
        • Yogev Y.
        Predictors of failed operative vaginal delivery: a single-center experience.
        Am J Obstet Gynecol. 2007; 197 (308.e1–5)
        • Bofill JA
        • Rust OA
        • Perry Jr, KG
        • Roberts WE
        • Martin RW
        • Morrison JC.
        Forceps and vacuum delivery: a survey of North American residency programs.
        Obstet Gynecol. 1996; 88: 622-625
        • Bofill JA
        • Rust OA
        • Perry KG
        • Roberts WE
        • Martin RW
        • Morrison JC.
        Operative vaginal delivery: a survey of fellows of ACOG.
        Obstet Gynecol. 1996; 88: 1007-1010
        • Dupuis O
        • Silveira R
        • Zentner A
        • et al.
        Birth simulator: reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification.
        Am J Obstet Gynecol. 2005; 192: 868-874
        • Kahrs BH
        • Usman S
        • Ghi T
        • et al.
        Sonographic prediction of outcome of vacuum deliveries: a multicenter, prospective cohort study.
        Am J Obstet Gynecol. 2017; 217 (69.e1–10)
        • Bultez T
        • Quibel T
        • Bouhanna P
        • Popowski T
        • Resche-Rigon M
        • Rozenberg P.
        Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure.
        Ultrasound Obstet Gynecol. 2016; 48: 86-91
        • Kasbaoui S
        • Séverac F
        • Aïssi G
        • et al.
        Predicting the difficulty of operative vaginal delivery by ultrasound measurement of fetal head station.
        Am J Obstet Gynecol. 2017; 216 (507.e1–9)
        • Maticot-Baptista D
        • Ramanah R
        • Collin A
        • Martin A
        • Maillet R
        • Riethmuller D
        [Ultrasound in the diagnosis of fetal head engagement. A preliminary French prospective study].
        J Gynecol Obstet Biol Reprod (Paris). 2009; 38: 474-480
        • von Elm E
        • Altman DG
        • Egger M
        • et al.
        Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 335: 806-808
        • Buchmann E
        • Libhaber E.
        Interobserver agreement in intrapartum estimation of fetal head station.
        Int J Gynaecol Obstet. 2008; 101: 285-289
        • Barros JG
        • Afonso M
        • Martins AT
        • et al.
        Transabdominal and transperineal ultrasound vs routine care before instrumental vaginal delivery - a randomized controlled trial.
        Acta Obstet Gynecol Scand. 2021; 100: 1075-1081
        • Dall'Asta A
        • Rizzo G
        • Ghi T.
        Intrapartum ultrasound before instrumental vaginal delivery: clinical benefits are difficult to demonstrate.
        Acta Obstet Gynecol Scand. 2021; 100: 988-989
        • Rivaux G
        • Dedet B
        • Delarue E
        • Depret S
        • Closset E
        • Deruelle P.
        [The diagnosis of fetal head engagement: transperineal ultrasound, a new useful tool?].
        Gynecol Obstet Fertil. 2012; 40: 148-152
        • Eggebø TM
        • Gjessing LK
        • Heien C
        • et al.
        Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term.
        Ultrasound Obstet Gynecol. 2006; 27: 387-391
        • Tutschek B
        • Torkildsen EA
        • Eggebø TM.
        Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor.
        Ultrasound Obstet Gynecol. 2013; 41: 425-429
        • Verma GL
        • Spalding JJ
        • Wilkinson MD
        • Hofmeyr GJ
        • Vannevel V
        • O'Mahony F
        Instruments for assisted vaginal birth.
        Cochrane Database Syst Rev. 2021; 9CD005455
        • Ghi T
        • Eggebø T
        • Lees C
        • et al.
        ISUOG practice guidelines: intrapartum ultrasound.
        Ultrasound Obstet Gynecol. 2018; 52: 128-139
        • Magnard C
        • Perrot M
        • Fanget C
        • Paviot-Trombert B
        • Raia-Barjat T
        • Chauleur C.
        [Instrumental delivery with perineum-fetal head distance >55 MM on ultrasound].
        Gynecol Obstet Fertil. 2016; 44: 82-87
        • Tabard F
        • Feyeux C
        • Peyronel C
        • et al.
        [Correlation between the perineal-to-skull measurement by tranperineal ultrasound, failure of vaginal operative delivery and maternal-fetal morbidity].
        J Gynecol Obstet Biol Reprod (Paris). 2013; 42: 541-549