Validation of Ultrasound "Angle of Progression" Measurement to Decrease the Cesarean Rate

Validation of Ultrasound "Angle of Progression" Measurement to Decrease the Cesarean Rate : a Randomized Comparative Multicenter Prospective Study.

Ultrasound during labor and measurement of Angle of progression showed extensive prospective and retrospective publications since 2010. The investigators performed between 2013 and 2016 the only one multicenter, randomized controlled Trial comparing digital exam to angle of progression after a prolonged 2-hour second stage of labor with uncertain fetal head. The investigators consider a cut off of 120° to accepted vaginal birth among cephalic occiput anterior position This randomised PILOT study showed that measurement of Angle of progression in addition to digital exam reduced caesarean delivery from 41% to12% ( n= 33, p=0,06). doi: 10.1016/j.ajog.2022.04.018.

The objective of this new study is therefore to validate the results of this PILOT study in a more powerful multicenter randomized trial (DELIVERY).

Inclusion Criteria:

• Nulliparous or multiparous women with no history of vaginal delivery,
• > or = 37 weeks amenorrhoea
• Cephalic presentation in anterior position (occipito-pubic position, left anterior occipito-iliac and right anterior occipito-iliac ) confirmed by ultrasound
• uncertain fetal head engagement on digital examination or midline fetal presentation in prolonged second stage of labor (at least 2 hours),

Exclusion Criteria:

• Multiparous women who were previous vaginal deliveries,
• Presentation other than cephalic,
• Twin pregnancies,
• Posterior or transverse position
• Transperineal ultrasound for head-perineum distance measurement
• Fetal heart rate abnormalities requiring rapid delivery,
• Contraindication to vaginal delivery whether maternal or fetal