UOG Journal Club: March 2012Agreement between two- and three-dimensional transperineal ultrasound   methods in assessing f...
Background Transperineal ultrasound (TPU) can assess fetal head descent before and during labor The literature is sparse o...
Agreement between two- and three-dimensional transperineal ultrasound    methods in assessing fetal head descent in the fi...
Agreement between two- and three-dimensional transperineal ultrasound     methods in assessing fetal head descent in the f...
Agreement between two- and three-dimensional transperineal ultrasound        methods in assessing fetal head descent in th...
Agreement between two- and three-dimensional transperineal ultrasound       methods in assessing fetal head descent in the...
Agreement between two- and three-dimensional transperineal ultrasound      methods in assessing fetal head descent in the ...
Agreement between two- and three-dimensional transperineal ultrasound     methods in assessing fetal head descent in the f...
Agreement between two- and three-dimensional transperineal ultrasound   methods in assessing fetal head descent in the fir...
Agreement between two- and three-dimensional transperineal ultrasound             methods in assessing fetal head descent ...
Agreement between two- and three-dimensional transperineal ultrasound       methods in assessing fetal head descent in the...
Agreement between two- and three-dimensional transperineal ultrasound       methods in assessing fetal head descent in the...
Agreement between two- and three-dimensional transperineal ultrasound        methods in assessing fetal head descent in th...
Agreement between two- and three-dimensional transperineal ultrasound        methods in assessing fetal head descent in th...
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UOG Journal Club: Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor

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This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:

Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor

This can be accessed here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.9065/abstract

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UOG Journal Club: Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor

  1. 1. UOG Journal Club: March 2012Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor E. A. Torkildsen, K. Å. Salvesen and T. M. Eggebø Volume 39, Issue 3, Date: March 2012, pages 310–315 Journal Club slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
  2. 2. Background Transperineal ultrasound (TPU) can assess fetal head descent before and during labor The literature is sparse on this subject, and there is no agreement regarding the superiority of 3D versus 2D ultrasound to assess fetal head descent Although 2D and 3D transperineal ultrasound in the labor ward are reproducible and repeatable techniques, the intermethod agreement between 2D and 3D techniques has not been investigated
  3. 3. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Objective: to study intraobserver repeatability andintermethod agreement between 2D and 3D ultrasound inassessing fetal head descent during the first stage of labor
  4. 4. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Two transperineal ultrasound (TPU) parameters were assessed in the study Head–perineum distance Angle of progression (Eggebø UOG 2006) (Barbera UOG 2009)• The shortest distance between the outer limit • The angle between the pubic symphysisof the fetal skull and the perineum and a line tangential to the fetal skull• Assessed in a transverse view • Assessed in a mid-sagittal view
  5. 5. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Patients and Methods• 106 primiparous women with a live singleton term fetus in cephalic presentation and a diagnosis of prolonged first stage were included in the study• Women were examined in the lithotomy position, with empty bladder, after rupture of membranes and between contractions For each woman both the “angle of progression” and “fetal head–perineum distance” were assessed using two different methods of acquisition 2D 3D (one volume acquired and analyzed later 3 (3 acquisitions) times for each parameter)• All volumes and images were obtained and stored by one operator without measured values, and all 2D and 3D measurements were later performed by another operator blinded to clinical assessment and labor outcome
  6. 6. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Statistical analysis Intraobserver repeatability Intermethod agreement (2D–3D) Was expressed as: Was performed using:1. the difference between the highest and 1. the mean of 3 measurements for each lowest measurements technique2. the intraclass correlation coefficient 2. Intermethod agreement was expressed using (ICC) the two-way random effects ICC3. the repeatability coefficient (the range 3. Cohen’s kappa was used to assess agreement within which two measurements by the for categorical data same observer will fall for 95% of subjects) In addition, linear regression analysis was performed to investigate the association between angle of progression and fetal head–perineum distance (expressed using the Pearson correlation coefficient – “r”)
  7. 7. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Results: Intraobserver repeatability Fetal head–perineum distance 2D 3DMean measurement (mm) 40.1 39.3 Repeatability coefficient ± 4.1 ± 1.7 (mm) ICC (95% CI) 0.94 (0.92–0.96) 0.99 (0.99–1.00) Angle of Progression 2D 3D Mean measurement (º) 108.7 111.0Repeatability coefficient (º) ± 6.7 ± 5.7 ICC (95% CI) 0.91 (0.87–0.93) 0.94 (0.91–0.96) ICC, intraclass correlation coefficient
  8. 8. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Results: Intermethod agreement Fetal head–perineum distance Angle of progression ICC (95% CI) 0.95 (0.93–0.97) 0.93 (0.89–0.95)Intermethod 95% limits -5.8 to +7.2 mm -8.9º to 13.7º of agreementMean 2D–3D difference 0.7 mm 2.4ºCohen’s kappa (95% CI) 0.85 * 0.79 † (0.75-0.95) (0.68-0.91) ICC, intraclass correlation coefficient * Using 40 mm as a cut-off level † Using 110º as a cut-off level
  9. 9. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Results: Bland–Altman plots of intermethod agreement between 2D and 3D measurements There was a significant, albeit small, mean difference over the range of the measured values for both fetal head–perineum distance and angle of progression. angle of progression
  10. 10. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Results: Association between angle of progression and fetal head–perineum distance 2D: r=−0.72 The association was significant at the 0.01 level for both the 2D (r=0.72) and 3D (r=0.71) scan methodsr = Pearson correlation coefficient
  11. 11. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Discussion• Both intraobserver repeatability and intermethod agreement between 2D and 3D acquisitions were good• The results suggest that 2D and 3D ultrasound might be used interchangeably in fetal head descent assessment in labor• The intraobserver repeatability was slightly better in 3D than 2D acquisitions• The association between angle of progression and fetal head– perineum distance was good for both 2D and 3D ultrasound
  12. 12. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Strength of the study• Inclusion of a large, homogeneous and well-defined population Weakness• Variation in 2D measurements was analyzed using three different acquisitions, while for 3D measurements the same acquired volume was uploaded three times• Possible bias due to the performance of the 3D invariably after the 2D evaluation which might have been the reason of wider angle (mean difference 2.4º) and shorter distance (mean difference, 0.7 mm) in 3D measurements observed in the study. However, the differences were small and probably lacking clinical importance
  13. 13. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Conclusion• The intraobserver repeatability and agreement between 2D and 3D ultrasound assessment of fetal head descent in labor is good• 2D and 3D ultrasound methods might be used interchangeably• These results may not be applicable to the second stage of labor where further studies are necessary
  14. 14. Agreement between two- and three-dimensional transperineal ultrasound methods in assessing fetal head descent in the first stage of labor Torkildsen et al., UOG 2012 Discussion points• What are the advantages of ultrasound over digital examination for management of labor?• What are the different ultrasound approaches that can be used to obtain images of the fetal head in labor?• What are the different ultrasound measurements that can be taken to assess progress in labor?• How useful are ultrasound methods in identifying fetal head position or predicting obstructed labor?• What do the study findings suggest would be the simplest, most reproducible technique for assessing labor progress?
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