Angles, Traction, and Time after Delivery of Fetal Head: Interobserver Variation of Novel Visual Analogs
10 March 2017
25 May 2017
26 June 2017 (eFirst)
Objective The objective was to ascertain interobserver variability for assessment of Angles of fetal head manipulation, Traction exerted on the fetal head, and Time interval from the emergence of the head to the feet (ATT) at vaginal delivery.
Materials and Methods Singleton pregnancies of ≥36 weeks with vaginal delivery were included. Visual analogs were created to assess angles and traction, and mobile phone stopwatch was used to assess the time interval. The intraclass coefficient (ICC) was calculated to determine interobserver variability.
Results Thirty-seven deliveries were analyzed. For the two observers, the median angle for downward manipulation was –5° vs –20° (interquartile range [IQR], –5 to –5 vs –30 to –10), ICC of 0.09 (poor agreement; 95% confidence interval [CI] –0.09, 0.32), and that for upward manipulation was 10° vs 20° (IQR, 10–15 vs 10–30), ICC of 0.25 (poor agreement; 95% CI –0.05, 0.52). ICC for lateral manipulation could not be calculated as it was not noted in 98% of deliveries. Mean traction was 2.5 versus 5.0, ICC of 0.36 (poor agreement; 95% CI –0.09, 0.72). The mean time intervals were 14.9 versus 14.0 seconds, ICC of 0.94 (excellent agreement, 95% CI 0.88–0.97).
Conclusion With exception of time interval, interobserver agreement was poor in estimation of fetal head manipulation and traction.
This study was presented as a poster presentation at the Central Association of Obstetricians and Gynecologists, Las Vegas, Nevada, October 25–29, 2016.
- 1 Shoulder dystocia. ACOG Practice Bulletin 40. Washington, DC: American College of Obstetricians and Gynecologists; 2002
- 2 Spong CY, Beall M, Rodrigues D, Ross MG. An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol 1995; 86 (03) 433-436
- 3 Beall MH, Spong C, McKay J, Ross MG. Objective definition of shoulder dystocia: a prospective evaluation. Am J Obstet Gynecol 1998; 179 (04) 934-937
- 4 Royal College of Obstetricians and Gynaecologists. Green top guidelines. Shoulder Dystocia. London, UK: RCOG; 2012; Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_42.pdf . Accessed June 5, 2013.
- 5 Chauhan SP, Laye MR, Lutgendorf M. , et al. A multicenter assessment of 1,177 cases of shoulder dystocia: lessons learned. Am J Perinatol 2014; 31 (05) 401-406
- 6 Hoffman MK, Bailit JL, Branch DW. , et al; Consortium on Safe Labor. A comparison of obstetric maneuvers for the acute management of shoulder dystocia. Obstet Gynecol 2011; 117 (06) 1272-1278
- 7 MacKenzie IZ, Shah M, Lean K, Dutton S, Newdick H, Tucker DE. Management of shoulder dystocia: trends in incidence and maternal and neonatal morbidity. Obstet Gynecol 2007; 110 (05) 1059-1068
- 8 Executive summary: Neonatal brachial plexus palsy. Report of the American College of Obstetricians and Gynecologists' Task Force on neonatal brachial plexus palsy. Obstet Gynecol 2014; 123 (04) 902-904
- 9 Task force on neonatal brachial plexus palsy. Washington, DC: American College of Obstetricians and Gynecologists; 2014
- 10 Mollberg M, Lagerkvist AL, Johansson U, Bager B, Johansson A, Hagberg H. Comparison in obstetric management on infants with transient and persistent obstetric brachial plexus palsy. J Child Neurol 2008; 23 (12) 1424-1432
- 11 Leung TY, Stuart O, Sahota DS, Suen SS, Lau TK, Lao TT. Head-to-body delivery interval and risk of fetal acidosis and hypoxic ischaemic encephalopathy in shoulder dystocia: a retrospective review. BJOG 2011; 118 (04) 474-479
- 12 Lerner H, Durlacher K, Smith S, Hamilton E. Relationship between head-to-body delivery interval in shoulder dystocia and neonatal depression. Obstet Gynecol 2011; 118 (2 Pt 1): 318-322
- 13 Allen RH, Bankoski BR, Butzin CA, Nagey DA. Comparing clinician-applied loads for routine, difficult, and shoulder dystocia deliveries. Am J Obstet Gynecol 1994; 171 (06) 1621-1627
- 14 Gonik B, Zhang N, Grimm MJ. Defining forces that are associated with shoulder dystocia: the use of a mathematic dynamic computer model. Am J Obstet Gynecol 2003; 188 (04) 1068-1072
- 15 Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 1994; 6: 284-290
- 16 Crofts JF, Attilakos G, Read M, Sibanda T, Draycott TJ. Shoulder dystocia training using a new birth training mannequin. BJOG 2005; 112 (07) 997-999
- 17 Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 2005; 192 (06) 1795-1800 , discussion 1800–1802
- 18 Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38 (04) 210-218