Angle of progression for predicting second-stage cesarean delivery complications

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes

Background:

• Cesarean delivery is a common surgical procedure.
• Second-stage Cesarean deliveries, particularly for arrest of descent, present unique challenges.
• Identifying predictors of maternal morbidity is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To investigate the correlation between the angle of progression (AOP) and maternal surgical complications.
• To determine if AOP can predict adverse maternal outcomes in second-stage Cesarean deliveries.

Main Methods:

• Retrospective evaluation of singleton pregnancies undergoing Cesarean delivery for arrest of descent at the second stage of labor.
• Inclusion of cases with recorded angle of progression (AOP) assessed via transabdominal ultrasound.
• Composite adverse maternal outcome defined as challenging fetal extraction, uterine extension, blood transfusion, postpartum fever, ileus, or re-hospitalization.

Main Results:

• Twenty-five cases met inclusion criteria; 40% experienced composite adverse maternal outcomes.
• Wider mean AOP was observed in patients with maternal morbidity (136.7° ± 7.4° vs. 124.7° ± 12.5°, p = .017).
• A significant correlation was found between AOP and composite adverse maternal outcome (OR = 1.15, p = .028), with an AUC of 0.79 for AOP prediction.

Conclusions:

• A correlation exists between the angle of progression and maternal complications in second-stage Cesarean deliveries.
• Pre-operative assessment of AOP may aid in identifying patients at higher risk for adverse outcomes.
• This finding suggests AOP could be a valuable tool for surgical planning and risk stratification.