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Simple models to predict vaginal delivery and spontaneous fetal occiput rotation based on intrapartum ultrasound and maternal characteristics
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  • Cheng Chen,
  • Xiaoxing Zhang,
  • Xiaohan Guo,
  • Hangkai Bao,
  • Peiying Luo,
  • Huaqin Yang,
  • Yali Wang,
  • Yimin Zhou,
  • Xiaofu Yang,
  • Xia Ying,
  • baihui zhao,
  • Qiong Luo
Cheng Chen
Womens Hospital, Zhejiang University School of Medicine
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Xiaoxing Zhang
Zhejiang University
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Xiaohan Guo
Womens Hospital, Zhejiang University School of Medicine
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Hangkai Bao
Womens Hospital, Zhejiang University School of Medicine
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Peiying Luo
Zhejiang University
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Huaqin Yang
Zhejiang University
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Yali Wang
Changxing Maternity and Child Health Care Hospital
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Yimin Zhou
Womens Hospital, Zhejiang University School of Medicine
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Xiaofu Yang
Womens Hospital, Zhejiang University School of Medicine
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Xia Ying
Womens Hospital, Zhejiang University School of Medicine
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baihui zhao
Zhejiang University
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Qiong Luo
Womens Hospital, Zhejiang University School of Medicine
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Abstract

Objective: To develop the prediction models for identifying fetal occiput rotation and vaginal delivery based on intrapartum sonographic findings. Design: Prospective observational study. Setting: Hangzhou, China. Population: Nulliparous women with a singleton cephalic presentation at term. Methods: Serial intrapartum ultrasonography were performed in the latent phase (T1) and every three hours after that (T2, T3 and T4). The managing clinicians performed paired digital vaginal examinations to assess labor progress. Main Outcome Measures: Delivery mode and successful internal fetal head rotation to the occiput anterior (OA) position. Results: 614 women were included, of whom 524 underwent vaginal delivery, and 90 required cesarean section. The percentage of women with fetuses in non-occiput anterior position at the latent phase was 53.9% (331 cases), as 257 women underwent spontaneous rotation to OA position before delivery, 74 were with persistent occiput posterior or transverse position. We developed a model on the basis of the maternal height and middle angel to predict the spontaneous fetal occiput rotation, with the area under the receiver operating characteristic curve (AUC) was 0.667 (95%CI 0.583-0.751). Moreover, a prediction model based on the maternal height and angle of progression to evaluate whether women underwent vaginal delivery was also developed, of which the AUC was 0.738(95% CI: 0.763-0.793). Both models showed satisfactory calibration. Conclusion: Simple models based on maternal characteristics and intrapartum ultrasound findings might provide useful information for predicting vaginal delivery and internal fetal occiput rotation.