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dc.contributor.authorKahrs, B H
dc.contributor.authorUsman, S
dc.contributor.authorGhi, T
dc.contributor.authorYoussef, A
dc.contributor.authorTorkildsen, E A
dc.contributor.authorLindtjørn, E
dc.contributor.authorØstborg, T B
dc.contributor.authorBenediktsdottir, S
dc.contributor.authorBrooks, L
dc.contributor.authorHarmsen, L
dc.contributor.authorSalvesen, K Å
dc.contributor.authorLees, C C
dc.contributor.authorEggebø, T M
dc.date.accessioned2019-10-29T12:55:16Z
dc.date.available2019-10-29T12:55:16Z
dc.date.issued2019-10
dc.date.submitted2019-10
dc.identifier.citationDescent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery. 2019, 54(4):524-529 Ultrasound Obstet Gynecolen_US
dc.identifier.issn1469-0705
dc.identifier.pmid31115115
dc.identifier.doi10.1002/uog.20348
dc.identifier.urihttp://hdl.handle.net/2336/621125
dc.descriptionTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloaden_US
dc.description.abstractOBJECTIVES: To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. METHODS: This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head-perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. RESULTS: The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01-1.08). Mean ΔHPD was 7 mm (range, -10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5-min Apgar score < 7 and ΔHPD quartile. CONCLUSION: Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.en_US
dc.description.sponsorshipLiaison Committee for education, research and innovation in Central Norway National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London Helen Lawson British Medical Association Grant Imperial Confidence in Concept grant Imperial College Healthcare NHS Trusten_US
dc.language.isoenen_US
dc.publisherWileyen_US
dc.relation.urlhttps://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.20348en_US
dc.subjectCesarean sectionen_US
dc.subjectduration of vacuum extractionen_US
dc.subjecthead-perineum distanceen_US
dc.subjectsecond stage of laboren_US
dc.subjecttransperineal ultrasounden_US
dc.subjectFæðingarlækningaren_US
dc.subjectFæðingartangiren_US
dc.subjectKeisaraskurðiren_US
dc.subject.meshLabor Stage, Seconden_US
dc.subject.meshVacuum Extraction, Obstetricalen_US
dc.subject.meshCesarean Sectionen_US
dc.subject.meshUltrasonographyen_US
dc.titleDescent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery.en_US
dc.typeArticleen_US
dc.contributor.department1 National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway. 2 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 3 Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK. 4 Parma University Hospital, Parma, Italy. 5 St Orsola Malpighi University Hospital, Bologna, Italy. 6 Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway. 7 Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden. 8 Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland. 9 Hvidovre University Hospital, Copenhagen, Denmark.en_US
dc.identifier.journalUltrasound in Obstetrics and Gynecologyen_US
dc.rights.accessOpen Access - Opinn aðganguren_US
dc.departmentcodeOAG12
dc.source.journaltitleUltrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
refterms.dateFOA2019-10-29T12:55:18Z


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