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Comment on: Predicting the difficulty of operative vaginal delivery by ultrasound measurements of the fetal head station

Published:September 15, 2017DOI:https://doi.org/10.1016/j.ajog.2017.09.006
      To the Editors:
      I read with interest the study by Kasbaoui et al,
      • Kasbaoui S.
      • Severac F.
      • Aissi G.
      • et al.
      Predicting the difficulty of operative vaginal delivery by ultrasound measurement of fetal head station.
      who investigated the clinical usefulness of measuring the perineum-to-skull ultrasound distance to predict the difficulty of operative vaginal delivery. However, I cannot agree with the conclusion reached. To perform operative vaginal delivery, I believe that the position of the largest circumference of the fetal head is more important than that of the lowest part of the fetal head. We sometimes have encountered cases in which the position of the largest circumference was higher than the pelvic inlet, whereas the lowest part was descending because of molding of the fetal head, particularly in cases of occiput-posterior presentation. During forceps delivery, it is possible to feel the presence or absence of the descent of the largest circumference of the fetal head; however, during vacuum extraction, it may sometimes be misidentified in the presence or absence of the descent of the fetal head because of the advanced molding of the fetal head and/or advanced formation of caput succedaneum. Therefore, it may be more useful to examine the position of the largest circumference of the fetal head by transabdominal ultrasonography before operative vaginal delivery.

      Reference

        • Kasbaoui S.
        • Severac F.
        • Aissi G.
        • et al.
        Predicting the difficulty of operative vaginal delivery by ultrasound measurement of fetal head station.
        Am J Obstet Gynecol. 2017; 216: 507.e1-507.e9

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