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Year : 2020  |  Volume : 33  |  Issue : 4  |  Page : 1286-1292

Angle of progression in women undergoing trial of labor after cesarean section in predicting mode of delivery

1 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Obstetrics, Berket El-Sabaa Hospital, Menoufia, Egypt

Correspondence Address:
Saly S Abd-Elbaset
MBCH, Berket El-Sabaa, Menoufia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_203_20

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Objective To assess the ability of ultrasonic measurement of angle of progression (AOP) in predicting mode of delivery in women undergoing vaginal birth after cesarean section (CS). Background The intrapartum ultrasound measurement of AOP is reliable regardless of the fetal head station assessed manually or the clinician's level of ultrasound experience. Patients and methods A prospective observational study was conducted from March 2019 to January 2020 at Menoufia University Hospital, including 100 patients with a history of previous one CS in spontaneous labor. Patients were followed up, and AOP was measured in them using transperineal ultrasound. Patients were divided into two groups according to mode of delivery as follows: group 1, delivered by CS, and group 2, delivered by normal vaginal delivery (NVD). Results The mean AOP was decreased in CS group (98.20 ± 15.83) than NVD group (112.21 ± 12.66). Additionally, at cutoff point of AOP less than 95 (86°), area under curve was 0.511 (95% confidence interval: 0.264–0.758; P = 0.024), with sensitivity of 71.4%, specificity of 85.5%, and accuracy 81.5%. However, at cutoff point of AOP more than 95 (113°), area under curve was 0.545 (95% confidence interval: 0.412–0.679; P = 0.016), with sensitivity of 85.7%, specificity of 69.4%, and accuracy 93.25%. Conclusions The AOP was significantly decreased in CS group than NVD group. The results prove a vital role for using this angle as a simple and accurate landmark to evaluate station of fetal head and provide a useful predictor for mode of delivery, particularly in patients with planned vaginal birth after cesarean delivery (VBAC).

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