• Antonio Sainz José J a Department of Obstetrics and Gynecology , Valme University Hospital , Seville , Spain . , Carlota Borrero, Adriana Aquise, José Antonio García-Mejido, Laura Gutierrez, and Ana Fernández-Palacín.
• a Department of Obstetrics and Gynecology , Valme University Hospital , Seville , Spain .
• J. Matern. Fetal. Neonatal. Med. 2016 Oct 1; 29 (20): 3400-5.

ObjectiveOur aim is to evaluate the capacity of intrapartum translabial ultrasound (ITU) with pushing in the prediction of difficulty of fetal extraction in vacuum assisted deliveries. Prospective, observational study performed (2/2015-8/2015) on 75 nulliparous women, ≥37 weeks with singleton pregnancies at full dilatation who had ITU-with-pushing performed, previous to vacuum-placement for fetal extraction. Working on the translabial sagittal-plane, we assessed: Angle-Progression (AoP), Progression-Distance (PD) and Head-Direction (HD); in the axial plane we evaluated: Midline-Angle (MLA) and Head-Perineum-Distance (HPD). Vacuum extractions were classified as easy-difficulty (ED) (≤3 vacuum-pulls), difficult-unsuccessful (DD) (>3 vacuum-pulls). We did not assess occipito-posterior-presentations.ResultsSeventy nulliparous were studied (44-ED,26-DD). We observed no differences in obstetric, neonatal or intrapartum characteristics between the two study groups, with the following exceptions: newborn weight (3272 ± 438 g versus 3540 ± 372 g; p = 0.011) and number of vacuum-pulls (1.4-ED-vs-4.4-DD; p < 0.0005). AoP-pushing was 143.9° ± 14.6° in ED and 115.1°± 12.9° in DD (p < 0.0005); Head-Up was 79.5% versus 38.4% (p < 0.0005); PD-Pushing was 42.7 ± 11.3 mm versus 30.4 ± 9.8 mm (p < 0.0005); MLA-Pushing was 27.6°± 26.6° versus 57.5°±26.5°(p=0.025); HPD-Pushing was 40.8 ± 10.0 mm versus 47.4 ± 10.9 mm (p = 0.039).ConclusionWe identified that the presence of an AoP-Pushing > 128° predicts an Easy-Vacuum-Delivery (≤3 Vacuum-Pulls) in  >85% of cases (Sen 80%-FPR 9.3%).

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