Sonographic risk assessment for an unplanned operative delivery: a prospective study

Sharon Perlman*, Hanoch Schreiber, Zvi Kivilevitch, Ron Bardin, Eran Kassif, Reuven Achiron, Yinon Gilboa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery. Methods: In this prospective study, nulliparous women were recruited at 37.0–42.0 weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD. Results: Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118. Conclusion: Sonographic parameters representing maternal pelvic configuration (PAA) and maternal–fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.

Original languageEnglish
Pages (from-to)1469-1475
Number of pages7
JournalArchives of Gynecology and Obstetrics
Issue number5
StatePublished - Nov 2022


  • Angle of progression
  • Pubic arch angle
  • Unplanned operative delivery


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