Comparison of different methods of measuring angle of progression in prediction of labor outcome

Journal article


Frick, A., Kostiv, V., Vojtassakova, D., Akolekar, R. and Nicolaides, K. H. 2020. Comparison of different methods of measuring angle of progression in prediction of labor outcome. Ultrasound in Obstetrics and Gynecology. 55 (3), pp. 391-400. https://doi.org/10.1002/uog.21913
AuthorsFrick, A., Kostiv, V., Vojtassakova, D., Akolekar, R. and Nicolaides, K. H.
Abstract

Objective: First, to compare the manual sagittal and para-sagittal and automated para-sagittal methods of measuring the angle of progression (AOP) by transperineal ultrasound during labor, and second, to develop models for the prediction of time-to-delivery and need for cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor.

Methods: This was a prospective observational study of transperineal ultrasound on a cohort of 512 women with singleton pregnancies undergiong induction of labor. A random selection of 50 stored images was assessed for inter- and intra-observer reliability between methods. In the cases of vaginal delivery univariate linear, multivariate linear and quantile regression were performed to predict time-to-delivery. Univariate and multivariate binomial logistic regression were performed to predict CS for FTP in the first stage of labor.

Results: The intra correlation coefficients (ICC) for the manual para-sagittal method for a single observer was 0.97 (CI 0.95-0.98) and for two observers was 0.96 (CI 0.93-0.98) indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (0.88-0.96) and for two observers was 0.74 (0.58-0.84) indicating moderate reliabilty for a single observer and poor reliability between two observers. Bland-Altman analysis demonstrated narrower limits of agreement for the manual para-saggittal approach than for the sagittal approach for both single and two observers. The automated para-sagittal method failed to capture an image in 19% of cases. The mean difference between sagittal and para-sagittal methods was 110. In pregnancies resulting in vaginal delivery, 54% of the variation in time-to-delivery was explained in a model combining parity, epidural and syntocinon use during labour and the sonographic findings of fetal head position and AOP. In the prediction of CS for FTP in the first stage of labour a model which combined maternal factors with the sonographic measurements of AOP and estimated fetal weight was superior to one utilising maternal factors alone (area under the curve 0.80 vs 0.76).

Conclusions: First, the method of measuring AOP with greatest reliability is the manual parasagittal technique and future research should focus on this technique, second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings, and third, the ability of AOP to provide clinically useful prediction CS for FTP in the first stage of labour is limited.

KeywordsAngle of progression; Intrapartum ultrasound; Transperineal ultrasound; Time-todelivery; Labor; Vaginal delivery
Year2020
JournalUltrasound in Obstetrics and Gynecology
Journal citation55 (3), pp. 391-400
PublisherWiley
ISSN0960-7692
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.21913
Official URLhttps://doi.org/10.1002/uog.21913
FunderFetal Medicine Foundation
Publication dates
Online02 Mar 2020
Publication process dates
Accepted24 Oct 2019
Deposited18 May 2020
Output statusPublished
Permalink -

https://repository.canterbury.ac.uk/item/8v411/comparison-of-different-methods-of-measuring-angle-of-progression-in-prediction-of-labor-outcome

Restricted files

Accepted author manuscript

  • 7
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of fetal abnormalities
Ficara, A., Syngelaki, A., Hammami, A., Akolekar, R. and Nicolaides, K. H. 2020. Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of fetal abnormalities. Ultrasound in Obstetrics and Gynecology. 55 (1), pp. 75-80. https://doi.org/10.1002/uog.20857
Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of non-cephalic presentation
De Castro, H., Ciobanu, A., Formuso, C., Akolekar, R. and Nicolaides, K. H. 2020. Value of routine ultrasound examination at 35-37 weeks' gestation in diagnosis of non-cephalic presentation. Ultrasound in Obstetrics and Gynecology. 55 (2), pp. 248-256. https://doi.org/10.1002/uog.21902
Diagnosis of fetal defects in twin pregnancies at routine 11-13-week ultrasound examination
Syngelaki, A., Cimpoca, B., Litwinska, E., Akolekar, R. and Nicolaides, K. H. 2020. Diagnosis of fetal defects in twin pregnancies at routine 11-13-week ultrasound examination. Ultrasound in Obstetrics and Gynecology. 55 (4), pp. 474-481. https://doi.org/10.1002/uog.21938
Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring
Panagiotopoulou, O., Syngelaki, A., Georgiopoulos, G., Simpson, J., Akolekar, R., Shehata, H., Nicolaides, K. H. and Charakida, M. 2020. Metformin use in obese mothers is associated with improved cardiovascular profile in the offspring. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2020.01.054
ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID-19
Abu-Rustum, R. S., Akolekar, R., Sotiriadis, A., Salomon, L. J., Da Silva Costa, F., Wu, Q., Frusca, T., Bilardo, C. M., Prefumo, F. and Poon, L. C. 2020. ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID-19. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.22029
Impaired placental perfusion and major fetal cardiac defects
Fantasia, I., Andrade, W., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Impaired placental perfusion and major fetal cardiac defects. Ultrasound in Obstetrics and Gynecology. 53 (1), pp. 68-72. https://doi.org/10.1002/uog.20149
Routine first-trimester screening for fetal trisomies in twin pregnancy: cell-free DNA test contingent on results from combined test
Galeva, S., Konstantinidou, L., Gil, M.M., Akolekar, R. and Nicolaides, K.H. 2019. Routine first-trimester screening for fetal trisomies in twin pregnancy: cell-free DNA test contingent on results from combined test. Ultrasound in Obstetrics and Gynecology. 53 (2), pp. 208-213. https://doi.org/10.1002/uog.20160
ALEX Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio
Ciobanu, A., Wright, A., Syngelaki, A., Wright, D., Akolekar, R. and Nicolaides, K.H. 2019. ALEX Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound in Obstetrics and Gynecology. 53 (4), pp. 465-472. https://doi.org/10.1002/uog.20157
Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor
Fiolna, M., Kostiv, V., Anthoulakis, C., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor. Ultrasound in Obstetrics and Gynecology. 53 (4), pp. 473-480. https://doi.org/10.1002/uog.20173
Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35-37 weeks' gestation
Ciobanu, A., Rouvali, A., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35-37 weeks' gestation. American Journal of Obstetrics & Gynecology. 220 (5), pp. 486.e1-486.e11. https://doi.org/10.1016/j.ajog.2019.01.227
Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks
Ciobanu, A., Formuso, C., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks. Ultrasound in Obstetrics and Gynecology. 53 (4), pp. 488-495. https://doi.org/10.1002/uog.20243
Routine assessment of cerebroplacental ratio at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Akolekar, R., Ciobanu, A., Zingler, E., Syngelaki, A. and Nicolaides, K.H. 2019. Routine assessment of cerebroplacental ratio at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. American Journal of Obstetrics & Gynecology. 221 (1), pp. 65.e1-65.e18. https://doi.org/10.1016/j.ajog.2019.03.002
Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates
Ciobanu, A., Khan, N., Syngelaki, A., Akolekar, R. and Nicolaides, K. H. 2019. Routine ultrasound at 32 vs 36 weeks' gestation: prediction of small-for-gestational-age neonates. Ultrasound in Obstetrics and Gynecology. 53 (6), pp. 761-768. https://doi.org/10.1002/uog.20258
Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks
Ciobanu, A., Anthoulakis, C., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks. Ultrasound in Obstetrics and Gynecology. 53 (5), pp. 630-637. https://doi.org/10.1002/uog.20267
Maternal and neonatal complications of fetal macrosomia: cohort study
Beta, J., Khan, N., Fiolna, M., Khalil, A., Ramadan, G. and Akolekar, R. 2019. Maternal and neonatal complications of fetal macrosomia: cohort study. Ultrasound in Obstetrics and Gynecology. 54 (3), pp. 319-325. https://doi.org/10.1002/uog.20279
Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis
Beta, J., Zhang, W., Geris, S., Kostiv, V. and Akolekar, R. 2019. Procedure-related risk of miscarriage following chorionic villus sampling and amniocentesis. Ultrasound in Obstetrics and Gynecology. 54 (4), pp. 452-457. https://doi.org/10.1002/uog.20293
Biomarkers of impaired placentation at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Ciobanou, A., Jabak, S., De Castro, H., Frei, L., Akolekar, R. and Nicolaides, K. H. 2019. Biomarkers of impaired placentation at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 54 (1), pp. 79-86. https://doi.org/10.1002/uog.20346
Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis
Salomon, L. J., Sotiriadis, A., Wulff, C. B., Odibo, A. and Akolekar, R. 2019. Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis. Ultrasound in Obstetrics and Gynecology. 54 (4), pp. 442-451. https://doi.org/10.1002/uog.20353
Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound
Khan, N., Ciobanu, A., Karampitsakos, T., Akolekar, R. and Nicolaides, K. H. 2019. Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound. Ultrasound in Obstetrics and Gynecology. 54 (2), pp. 326-333. https://doi.org/10.1002/uog.20377
Two-stage approach for prediction of small-for-gestational-age neonate and adverse perinatal outcome by routine ultrasound examination at 35-37 weeks' gestation
Akolekar, R., Panaitescu, A. M., Ciobanu, A., Syngelaki, A. and Nicolaides, K. H. 2019. Two-stage approach for prediction of small-for-gestational-age neonate and adverse perinatal outcome by routine ultrasound examination at 35-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 54, pp. 484-491. https://doi.org/10.1002/uog.20391
Prevention of stillbirths: impact of a two-stage screening for vasa previa
Zhang, W., Geris, S., Beta, J., Ramadan, G., Nicolaides, K. H. and Akolekar, R. 2019. Prevention of stillbirths: impact of a two-stage screening for vasa previa. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 605-612. https://doi.org/10.1002/uog.21953
Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta
Vigneswaran, T. V., Zidere, V., Chivers, S., Charakida, M., Akolekar, R. and Simpson, J. M. 2019. Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.21957
Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus
Minnella, G. P., Crupano, F. M., Syngelaki, A., Zidere, V., Akolekar, R. and Nicolaides, K. H. 2019. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 637-644. https://doi.org/10.1002/uog.21956
Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation
Dragan, I., Georgiou, T., Prodan, N., Akolekar, R. and Nicolaides, K. H. 2017. Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (1), pp. 73-77. https://doi.org/10.1002/uog.17301
Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (3), pp. 308-315. https://doi.org/10.1002/uog.14898
Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 194-202. https://doi.org/10.1002/uog.14928
Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result
Revello, R., Sarno, L., Ispas, A., Akolekar, R. and Nicolaides, K. H. 2016. Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 698-704. https://doi.org/10.1002/uog.15851
Metformin versus placebo in obese pregnant women without diabetes mellitus
Syngelaki, A., Nicolaides, K. H., Balani, J., Hyer, S., Akolekar, R., Kotecha, R., Pastides, A. and Shehata, H. 2016. Metformin versus placebo in obese pregnant women without diabetes mellitus. New England Journal of Medicine. 374, pp. 434-43. https://doi.org/10.1056/NEJMoa1509819
Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy
Sarno, L., Revello, R., Hanson, E., Akolekar, R. and Nicolaides, K. H. 2016. Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 705-11. https://doi.org/10.1002/uog.15913
Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks
Mastrodima, S., Akolekar, R., Yerlikaya, G., Tzelepis, T. and Nicolaides, K. H. 2016. Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 613-617. https://doi.org/10.1002/uog.17289
Prediction of stillbirth from maternal demographic and pregnancy characteristics
Yerlikaya, G., Akolekar, R., McPherson, K., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal demographic and pregnancy characteristics. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 607-612. https://doi.org/10.1002/uog.17290
Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies
Peeva, G., Chaveeva, P., Gil Guevara, E., Akolekar, R. and Nicolaides, K. H. 2016. Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies. Fetal Diagnosis and Therapy. 40 (3), pp. 174-180. https://doi.org/10.1159/000443792
Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks
Akolekar, R., Tokunaka, M., Ortega, N., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 624-630. https://doi.org/10.1002/uog.17295
Prediction of stillbirth from placental growth factor at 11-13 weeks
Akolekar, R., Machuca, M., Mendes, M., Paschos, V. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 618-623. https://doi.org/10.1002/uog.17288
Prediction of stillbirth from placental growth factor at 19-24 weeks
Aupont J. E., Akolekar, R., Illian, A., Neonakis, S. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 631-635. https://doi.org/10.1002/uog.17229
Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2015. Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 203-209. https://doi.org/10.1002/uog.15663