Intrapartum ultrasound measured angle-of-progression for prediction of assisted delivery outcome: a systematic review and meta-analysis

To determine whether intrapartum ultrasound measurement of angle of progression (AoP) during the second stage of labor can predict the success of assisted delivery. A systematic search in PubMed, Embase, Scopus, Web of science and the Google Scholar was performed from inception to February 2021 in order to find studies assessing the predictive accuracy of AoP measured by intrapartum ultrasound for outcome of assisted delivery. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Summary receiver–operating characteristics (sROC) curves, pooled sensitivities and specificities, area under curve (AUC), and summary likelihood ratios (LRs) were calculated. Seven studies reporting on 796 patients undergoing trial of assisted delivery were included in meta-analysis. Second stage AoP measured at maternal rest had pooled sensitivity of 80% (95% CI, 59–92%) and specificity of 89% (95% CI, 76–95%). On the other hand, AoP during push showed sensitivity of 91% (95% CI, 85–94%) and specificity of 83% (95% CI, 69–92%). AoP measurement had higher accuracy for primiparous women and those undergoing forceps delivery (as compared to vacuum). Angle of progression seems to be a reliable predictive factor for assisted delivery outcome, specially primiparous women and those undergoing forceps delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)