Can assessing the angle of progression before labor onset assist to predict vaginal birth after cesarean?: A prospective cohort observational study

Objective:To assess whether pre-labor measurement of the angle of progression (AOP) can assist in predicting a successful vaginal birth after cesarean in women without a previous vaginal birth. Methods:A prospective observational cohort study performed in a single tertiary center including women at term with a single previous cesarean delivery (CD), without prior vaginal births, who desire a trial of labor. Transperineal ultrasound was used to measure the AOP before the onset of labor. The managing staff in the delivery suite was blinded to the ultrasound measurements. Clinical data and delivery outcome were retrieved from medical records. The study was approved by the institutional ethics committee (KMC 0117-10). Results:Of the 111 women included in the study, 67 (60.4%) had a successful vaginal birth after CD. Women were sonographically assessed at a median of 3 days [interquartile range (IQR) 1-3 days] prior to delivery. The median AOP was significantly narrower in women who eventually underwent a CD than in those who delivered vaginally (88 degrees, IQR 78-96 degrees vs. 99 degrees, IQR 89-107 degrees, respectively;p < .001). An AOP >98 degrees (derived from a receiver operating characteristic curve) was associated with a successful vaginal birth after CD in 87.5% of women. Multivariable regression analysis demonstrated that each additional 1 degrees in the AOP increases the chance for a successful vaginal birth after CD by 6%. Conclusions:Pre-labor AOP may be a useful sonographic tool for predicting vaginal birth after CD and can assist in consulting primiparous women with a prior CD opting for a trial of labor.