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Clinical Obstetrics

Poster Session 1

(189) Pre-Labor Sonographic Assessment of Fetal Station as a Predictor of Cesarean Delivery

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Presenting Author(s)

DG

Dillon Gurciullo, MD (she/her/hers)

Lenox Hill Hospital, Department of Obstetrics and Gynecology
New York, NY, United States

Coauthor(s)

NC

Noel Cercizi, BA

University of Chicago
Chicago, IL, United States
Jessica Gulati, N/A

University of Chicago
Chicago, IL, United States
GK

Gloria Khafif, N/A

University of Chicago
Chicago, IL, United States
MB

Maria Teresa Benedetto, MD

Lenox Hill Hospital
New York City, NY, United States
TC

Teresa Cheon, MD

Lenox Hill Hospital
New York City, NY, United States
MS

Mio Sawai, MD

Attending Physician
Lenox Hill Hospital
New York City, NY, United States

Primary Author(s)

YA

Yuzuru Anzai, MD

Lenox Hill Hospital
New York, NY, United States

Objective: This study aims to determine if sonographic evaluation of fetal station before the onset of labor has an association with mode of delivery.

Study Design: This prospective cohort study enrolled pregnant patients who are nulliparous, singleton, with vertex presentation and no contraindication to labor. IRB approval was obtained. Transperineal sonography was performed after 36 weeks before the onset of labor with patients' written consent. We measured angle of progression (angle between the long axis of pubic bone and fetal skull) and distance (distance between perineum and fetal skull). Additional data included in the analysis were maternal age, height, prepregnancy weight, weight gain, BMI, birth weight, and mode of delivery. Multivariate and univariate logistic regression analyses were run on SPSS. A decision tree model with a train-test split of 0.5 was created using python machine learning algorithms.

Results: The study enrolled 220 patients, but 4 Cesarean deliveries (CD) were excluded due to fetal status prior to labor. 216 patients remained, with 18 CD, 149 spontaneous vaginal deliveries, 46 forceps assisted deliveries, and 2 vacuum assisted deliveries. Multivariate logistic regression showed distance was the most significant factor in determining CD (p = 0.013), followed by birth weight (p = 0.031) and height (p = 0.034). The decision tree model created using these three variables had an accuracy of ~90% with a specificity of 98% and sensitivity of 11%. Figure 1 displays the correlation between distance and CD.

Conclusion:
Short distance was strongly associated with vaginal delivery, consistent with a lower station of the fetal head in the pelvis, indicating low risk of inlet or mid-pelvis dystocia. The CD rate in this study is lower than the national average. However, since most CDs in this series were due to arrest disorder, this data may be better suited to characterize the effect of distance on mode of delivery. This measurement could provide clinically useful information to physicians. A larger dataset can further validate this analysis and allow for a more precise predictive model.