{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:02:27Z","timestamp":1787169747682,"version":"build-2736575974"},"reference-count":44,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T00:00:00Z","timestamp":1511308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI16\/01387"],"award-info":[{"award-number":["PI16\/01387"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004963","name":"Seventh Framework Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004963","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative (vacuum or forceps) deliveries in nulliparous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>Prospective observational study of nulliparous women with an indication for operative delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a third\u2010\/fourth\u2010degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 143 nulliparous women were included in the study (82 vacuum\u2010assisted deliveries and 61 forceps\u2010assisted deliveries), with 20 fetuses in occiput posterior position. Forty\u2010seven operative deliveries were classified as complicated deliveries (28 vacuum\u2010assisted deliveries, 19 forceps\u2010assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birthweight (3229\u00a0\u00b1\u00a0482 uncomplicated deliveries vs. 3623\u00a0\u00b1\u00a0406 complicated deliveries;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.003) and number of vacuum tractions (1.4 uncomplicated deliveries, 4.5 complicated deliveries;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0005). The strongest predictors of a complicated delivery, using the area under the receiver\u2010operating characteristics curve (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      ), were the angle of progression with active pushing (AoP2) (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      86.9%) and the progression distance with active pushing (\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      2) (\n                      <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n                      74.5%). The optimal cut\u2010off value for predicting a difficult operative delivery was an AoP2 of 153.5\u00b0 (sensitivity 95.2%; false\u2010positive rate 5.9%) or\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      2 of 58.5\u00a0mm (sensitivity 95.2%; false\u2010positive rate 7.1%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The sonographic parameters AoP2 and\n                      <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>\n                      2 can be used to predict cases of complicated operative deliveries in nulliparous women.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.13230","type":"journal-article","created":{"date-parts":[[2017,9,10]],"date-time":"2017-09-10T07:32:40Z","timestamp":1505028760000},"page":"1490-1497","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9571-3219","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Sainz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"},{"name":"Department of Obstetrics and Gynecology University of Seville Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 A.","family":"Garc\u00eda\u2010Mejido","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Aquise","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Bonomi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlota","family":"Borrero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paloma","family":"De La Fuente","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fern\u00e1ndez\u2010Palac\u00edn","sequence":"additional","affiliation":[{"name":"Biostatistics Unit Department of Preventive Medicine and Public Health University of Seville Seville Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,22]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"CD000224","article-title":"Vacuum extraction versus forceps for assisted vaginal delivery","volume":"11","author":"Johanson RB","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_3_1","first-page":"CD005545","article-title":"Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births","volume":"10","author":"Majoko F","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1247605"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200003000-00030"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-7292(93)90514-W"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.1996.tb01559.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412301"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06341-3"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-0528.2003.01463.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117309"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7456.24"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.01.004"},{"key":"e_1_2_8_14_1","first-page":"69","article-title":"Operative vaginal delivery. 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