The following is a summary of “Prediction of spontaneous vaginal delivery in the prolonged second stage using the delta angle of progression,” published in the June 2024 issue of Obstetrics & Gynecology by Yano et al.
Determining the optimal timing for intervention during the prolonged second stage of labor remains a clinical challenge. The ability to predict spontaneous vaginal delivery is crucial to mitigate the risks associated with operative interventions, yet a standardized approach for individualized prediction is lacking.
The study aimed to assess the predictability of spontaneous vaginal delivery using the delta angle of progression, which measures the difference in angle between pushing and resting phases. The researchers sought to establish a novel method for predicting spontaneous vaginal delivery during the prolonged second stage in nulliparous women under epidural anesthesia.
The study group conducted a retrospective analysis of deliveries involving nulliparous women under epidural anesthesia from September 2018 to October 2023. Participants were included if data on the delta angle of progression during the second stage were available. Cases requiring operative deliveries due to maternal or fetal concerns, including occiput posterior presentation, were excluded. The prolonged second stage was defined as extending beyond three hours, contrasting with the normal second stage up to three hours. The investigators investigated the association between the delta angle of progression during both stages and the likelihood of achieving spontaneous vaginal delivery versus operative delivery.
A total of 129 eligible women were analyzed. Significant differences in delta angle of progression were observed between those achieving spontaneous vaginal delivery versus operative delivery during both the prolonged (p<0.001) and normal (p<0.05) second stages. In the prolonged second stage, a delta angle cutoff of 18.8 derived from receiver operating characteristic curves predicted spontaneous vaginal delivery with sensitivity of 81.8% and specificity of 60.0% (AUC=0.76). Combining this measure with a resting angle of progression >140 provided enhanced predictive accuracy (sensitivity 86.7%, specificity 70.0%, AUC=0.80).
The delta angle of progression, alone or in conjunction with resting angle measurements, offers a reliable method for predicting spontaneous vaginal delivery in nulliparous women under epidural anesthesia during the prolonged second stage. This quantitative approach to assessing pushing efforts can assist clinicians in managing labor dystocia effectively, potentially reducing maternal and neonatal complications associated with unnecessary operative interventions and prolonged labor.
Source: sciencedirect.com/science/article/abs/pii/S2589933324001290
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