OP02.11: Intrapartum sonographic features of cephalopelvic disproportion in occiput anterior fetuses with protracted active phase of labour
Year: 2021
Type: conference-abstract
Abstract: A 35-year-old nullipara at 41 weeks of gestation was admitted in the active phase of the first stage of labour. Following epidural analgesia, a diagnosis of protracted active phase of labour was made. On examination head position was left occiput anterior (LOA) and the head station -2 as confirmed by a narrow angle-of progression (AoP) measuring 96.3° (figure 1A) and a long HPD measuring 6.2 cm (figure 1B); caput and moulding were also noted (figure 1C). Transabdominal ultrasound showed a favourable flexion of the fetal head with occiput-spine angle (OSA) measuring 167.8° (figure 1D). No progression of the cervical dilatation and head descent was observed after two hours of oxytocin administration, prompting a diagnosis of arrest of dilatation in the first stage. The clinical and sonographic findings were referred to as obstructed labour secondary to cephalopelvic disproportion (CPD) and an uncomplicated emergency Caesarean section was performed to accomplish the delivery of a 3.7 kg healthy neonate. Recent data from our group showed that in protracted active phase of labour OA fetuses submitted to Caesarean delivery (CD) appeared to pool in two clusters, one characterised by deflexed head and high station and another featured by high station and no obvious sign of malposition nor malpresentation, as it occurred in the reported case, and OSA/AoP ratio > 1.19 and a OSA/HPD ratio <2.72 showed a 100% and 77.8% sensitivity, respectively, for CD for labour dystocia. In such context, the co-existence of additional features of obstructed labour such as caput and moulding should lead to the suspicion of CPD, and CD should be considered to safely accomplish delivery. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
DOI: 10.1002/uog.23936
Authors: A. Dall'Asta, M. Minopoli, G. Cagninelli, S. Sorrentino, E. Corno, E. Melandri, A. Di Tonto, N. Volpe, T. Ghi
Institution: University of Parma
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3206579404