{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:15:07Z","timestamp":1789024507089,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T00:00:00Z","timestamp":1570147200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head\u2013perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (\u0394HPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values &gt;\u20091 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to \u0394HPD quartile, and delivery mode and neonatal outcome were compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing \u0394HPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5\u2009min in pregnancies with \u0394HPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing \u0394HPD as a continuous variable, was 1.04 (95%\u2009CI, 1.01\u20131.08). Mean \u0394HPD was 7\u2009mm (range, \u221210 to 37\u2009mm). \u0394HPD was either negative or \u2264\u20092\u2009mm in the lowest quartile. In this group, 7\/50 (14%) pregnancies were delivered by Cesarean section, compared with 8\/154 (5%) of those with \u0394HPD &gt;\u20092\u2009mm (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). There was no significant association between umbilical artery pH\u2009&lt;\u20097.10 or 5\u2010min Apgar score\u2009&lt;\u20097 and \u0394HPD quartile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. \u00a9 2019 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20348","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T09:34:09Z","timestamp":1558517649000},"page":"524-529","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7982-7646","authenticated-orcid":false,"given":"B. H.","family":"Kahrs","sequence":"first","affiliation":[{"name":"National Center for Fetal Medicine Trondheim University Hospital (St Olavs Hospital)  Trondheim Norway"},{"name":"Department of Clinical and Molecular Medicine Norwegian University of Science and Technology  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Usman","sequence":"additional","affiliation":[{"name":"Centre for Fetal Care Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1823-1096","authenticated-orcid":false,"given":"T.","family":"Ghi","sequence":"additional","affiliation":[{"name":"Parma University Hospital  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9322-2184","authenticated-orcid":false,"given":"A.","family":"Youssef","sequence":"additional","affiliation":[{"name":"St Orsola Malpighi University Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. A.","family":"Torkildsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Stavanger University Hospital  Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lindtj\u00f8rn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Stavanger University Hospital  Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. B.","family":"\u00d8stborg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Stavanger University Hospital  Stavanger Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Benediktsdottir","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinical Sciences Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Landspitali University Hospital  Reykjavik Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Hvidovre University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Harmsen","sequence":"additional","affiliation":[{"name":"Hvidovre University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. \u00c5.","family":"Salvesen","sequence":"additional","affiliation":[{"name":"National Center for Fetal Medicine Trondheim University Hospital (St Olavs Hospital)  Trondheim Norway"},{"name":"Department of Clinical and Molecular Medicine Norwegian University of Science and Technology  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2104-5561","authenticated-orcid":false,"given":"C. 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