Head perineal distance, Induction of labor, Predictor of successful vaginal delivery, Transperineal ultrasound
Citation Information :
Dasgupta S, Mittal P, Bharti R, Mittal M, Pandey D, Suri J. Fetal Head–Perineum Distance on Transperineal Ultrasound as Predictor of Vaginal Delivery in Term Nulliparous Women Undergoing Induction of Labor. Donald School J Ultrasound Obstet Gynecol 2022; 16 (3):174-180.
Aim: To study the association of fetal head perineum distance (HPD) on transperineal ultrasound (TPU) with the mode of delivery in women undergoing induction of labor (IOL).
Materials and methods: Term nulliparous women with singleton pregnancy in cephalic presentation, admitted in the obstetrics wards for IOL, were recruited in the study. After written informed consent, preinduction measurements of fetal HPD on digital vaginal examination (DVE) and TPU were done in 300 women. HPD on TPU was compared with HPD on DVE. Women were followed till delivery, association of HPD on TPU with the mode of delivery was noted, and receiver operating characteristic (ROC) was plotted for successful IOL.
Results: For successful vaginal delivery, the ROC cutoff for HPD on TPU was ≤4.39 cm (95% CI 0.860–0.931, p < 0.0001) with sensitivity, specificity, positive and negative predictive value, and likelihood ratio of 97.76, 75.32, 92, 92.1, and 3.96, respectively. HPD on TPU showed significant difference but good positive correlation with HPD on DVE (r = 0.886; 95% CI 0.859–0.908, p < 0.001). With every centimeter increase in the HPD from 4.39 cm, the likelihood of cesarean delivery increased by 47%. On multivariate analysis, HPD measured by TPU was found to be the most significant independent predictor of risk of cesarean delivery, p < 0.0001.
Conclusion: Fetal HPD on TPU in term nulliparous women undergoing IOL is a good predictor of vaginal delivery, and every centimeter increase in the HPD from 4.39 cm increases the risk of cesarean delivery by 47%.
Clinical significance: Fetal head perineal distance by TPU can be used for counseling primigravida regarding the outcome of IOL.
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