الفهرس 
Labor outcomeOnly 14 pages are availabe for public view
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Abstract
This study evaluate intrapartum fetal head
circumference and fetal weight as a sensitive majors for assessment of labor outcome.
The second stage is an important point at which the decision for mode of delivery and prediction of labor outcome should be setteled, it begins with complete cervical
dilatation and end with delivery of fetus, prolonged second
stage of labor should be 42 considered when the second stage
of labor exceeds 3 hours if regional anesthesia is
administered or 2 hours in the absence of regional
anesthesia for nulliparas. In multiparous women, such a
diagnosis can be made if the second stage of labor exceeds
2 hours with regional anesthesia or 1 hour without it
(Cunningham et al., 2010).
Studies performed to examine perinatal outcomes associated with a prolonged second stage of labor revealed
increased risks of operative deliveries and maternal
morbidities but no differences in neonatal outcomes (Cheng
et al., 2004, Janni et al., 2002).
Maternal risk factors associated with a prolonged
second stage include nulliparity, increasing maternal
weight and/or weight gain, use of regional anesthesia,
induction of labor, fetal occiput in a posterior or transverse sition, and increased birth weight (O’Connell et al., Senecal et al., 2005).
Although the 2003 ACOG practice guidelines state that: duration of the second stage alone does not mandate
ervention by operative vaginal delivery or cesarean
ivery if progress is being made, the clinician has several relationship with the second stage duration. Large FHC
relative to maternal pelvic diameter, is the main cause of
prolonged labor (Konje & Ladipo, 2000). And there for
increased risk of operative delivery (primary cesarean
section, vacuum assisted and forceps-assisted vaginal
delivery) (Elvander et al., 2012).
Intra partum head circumference Is an integral part of
sonographic models and important for the purpose of fetal
weight estimation (Hadlock et al., 1982) as well as in
cases which abnormal fetal head growth is suspected
(Hadlock et al., 1982) with some reviews suggesting that
it can replace biparietal diameter (Weiner et al., 1985).
The association between fetal head circumference and fetal weight and adverse maternal or neonatal outcome has been setteled. While a prolonged second stage is not associated with adverse neonatal outcomes in nulliparas, possibly because of close fetal monitoring during labor, but it is associated with increased maternal morbidity, including
her likelihood of operative vaginal delivery and
cesarean delivery, postpartum hemorrhage, third- or fourth-
degree perineal lacerations, and peripartum infection
(Wartin et al., 2000).
Not much work has been done in the area of predicting labor outcome using dimensions of fetal head and weight. This study was aimed at determining relationship with the labor outcome and incidence of primary cesarian section. Large FHC relative to maternal pelvic diameter, is the main cause of prolonged labor (Konje & Ladipo, 2000). And there for increased risk of operative delivery (primary cesarean
section, vacuum assisted and forceps-assisted vaginal
delivery) (Elvander et al., 2012).
Intra partum head circumference Is an essential part of
sonographic models and important for the purpose of fetal
weight estimation (Hadlock et al., 1982) as well as in
cases which abnormal fetal head growth is suspected
(Hadlock et al., 1982) with some reviews suggesting that
it can replace biparietal diameter (Weiner et al., 1985).
Large study by Chervenak et al., that evaluated
pregnancies conceived by in vitro fertilization and thus had
known conception dates, head circumference was found to
be the best predictor of gestational age compared with other
commonly used parameters (Chervenak et al., 1991). This
finding is in agreement with that of Hadlock (Hadlock el
al., 1984), (Ott et al., 1994) and Benson (Benson et aI.,
1991) who compared the performance of HC, BPD, FL and
AC in different populations.
The study included 100 women with the diagnosis of
the first of labor with at least cervical dilatation 4cm.
Each woman was subject to:-
• Evaluation of full obstetric history.
• General examination as regard general condition and vital data.
• Abdominal examination as regard fundal level, fetal position and fetal heart sound monitored by CTG.
• Vaginal examination as regard cervical dilatation, effacement and state of membranes.
• According to the hospital standards in the labor room, patients will be managed.
All women included in our study were examined by trans-abdominal ultra-sound using Mindray dp6900 set in labor ward to measure the fetal head circumference and fetal weight.
Then post-natal fetal head circumference and fetal weight were measured and recorded.
Outcome was classified into:
• Primary outcome: cesarian section rate
• Secondary outcomes: matermal and fetal complications result as a direct effect to the mode of delivery.
Maternal complications:
Birth canal and pelvic floor injuries, instrumental and operative vaginal deliveries, traumatic and atonic post partum haemorrhage.
Neonatal complications:
Birth asphyxia, shoulder dystocia, birth injuries, metabolic disorders, meconium aspiration syndrome, and still birth.
Finally assessing the critical range of fetal head circumference in cm and fetal weight in grams at which these women are subjected to complicated labour.
The result showed there was significant association
between intra partum fetal head circumference (IPFHC)
with gestational age, postpartum fetal head circumference
and fetal weight. And no significant association between
intra partum fetal head circumference and age, body mass
index.
Receiver Operator characteristics curves (ROC)
indicated that intrapartum fetal head circumference is 34.6 cm and intrapartum fetal weight is 3410 kg are the best cut of levels for predicting the prolonged labor and consequent labor complications.
Cesarean delivery rate was 5.6% among 72 women
with small fetal head circumference (less than 34.6 cm) and 100 % among 28 women with large fetal head circumference (more than 34.6 cm).
Small fetal weight (less than 3410 kg) showed
0% incidence of cesarian section within 49 women and large fetal weight (>3410 kg) show 62.7% incidence of cesarian section among 51 women.