The Effects of Fetal Head Circumference on The Duration of Labor and Cesarean Section in Term Pregnancy
-
Masomeh Sabzevary
,
Mahboobeh Shirazi
,
Fatemeh Rahimi
,
Fatemeh Golshahi
,
Zahra Moghimi
,
Ehsan Sobhanian
,
Morteza Naderan
Abstract
Background: To investigate whether fetal head circumference (FHC), independent of estimated fetal weight
(EFW), is a risk factor for prolonged second stage of labor and cesarean delivery in term pregnancy.
Methods: A single-center, non-randomized cross-sectional study including 580 cases was conducted. Cases
included singleton primigravida term pregnancies.
Results: In the vaginal delivery and cesarean groups, the FHC was 35.01 ± 1.18 cm and 35.02 ± 1.32 cm,
respectively (P = 0.95); biparietal diameter (BPD) was 94.99 ± 0.65 mm and 94.96 ± 0.65 mm, respectively (P =
0.66); EFW was 3366.18 ± 207.04 g and 3363.03 ± 251.54 g, respectively (P = 0.34). The lengths of the first and
second stages of labor were not associated with the type of delivery (P₁ = 0.92; P₂ = 0.79). BMI was significantly
associated with the duration of the first stage of labor (P₁ = 0.04), but not the second stage (P₂ = 0.87). BPD was
significantly associated with the duration of the first stage (P₁ = 0.007), but not the second stage (P₂ = 0.57). EFW
was not associated with either stage (P₁ = 0.68; P₂ = 0.73). FHC was significantly correlated with the duration of
the second stage of labor (P < 0.01).
Conclusions: Among various maternal and fetal parameters, FHC was correlated with prolonged second stage
of labor without increasing the risk of cesarean delivery. The decision regarding planned cesarean should not be
based on FHC in uncomplicated pregnancies.
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14. Kabiri D, Lipschuetz M, Cohen SM, et al. Vacuum extraction failure is associated with a large head circumference. J Matern Fetal Neonatal Med. 2018;31(9):1162–7. https://doi.org/10.1080/14767058.2017.1277717
15. Lipschuetz M, Cohen SM, Lewkowicz D, et al. Prolonged second stage of labor: causes and outcomes. Harefuah. 2018 Nov;157(11):685–90.
16. Rizzo G, Aiello E, Bosi C, et al. Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand. 2017 Jul;96(7):1006–11. https://doi.org/10.1111/aogs.13189
17. Elgarhy IT, Sabry NM, Abdelkader HM, et al. The influence of fetal head circumference and fetal weight assessed by intrapartum ultrasound on labor outcome. Egypt J Hosp Med. 2019 Aug;74(8):1785–90.
18. Larson A, Mandelbaum DE. Association of head circumference and shoulder dystocia in macrosomic neonates. Matern Child Health J. 2013 Mar;17(3):501–4. https://doi.org/10.1007/s10995-012-1013-x
19. Kjaergaard H, Olsen J, Ottesen B, Nyberg P, Dykes AK. Obstetric risk indicators for labor dystocia in nulliparous women: a multicentre cohort study. BMC Pregnancy Childbirth. 2008 Sep;8:45. https://doi.org/10.1186/1471-2393-8-45
20. Mujugira A, Osoti A, Deya R, Hawes SE, Phipps AI. Fetal head circumference, operative delivery, and fetal outcomes: a multiethnic populationbased cohort study. BMC Pregnancy Childbirth. 2013 Jun;13:106. https://doi.org/10.1186/1471-2393-13-106
21. Groutz A, Hasson J, Wengier A, et al. Third and fourthdegree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol. 2011 Apr;204(4):347.e1–4. https://doi.org/10.1016/j.ajog.2010.11.030
22. Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum hemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch populationbased cohort study on standard and severe postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004 Jun;115(2):166–72. https://doi.org/10.1016/j.ejogrb.2003.10.010
23. Fuchs F, Bouyer J, Rozenberg P, Senat MV. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birthweight? BMC Pregnancy Childbirth. 2013 May;13:90. https://doi.org/10.1186/1471-2393-13-90
24. Noumi G, Collado-Khoury F, Bombard A, Julliard K, Weiner Z. Clinical and sonographic estimation of fetal weight performed during labor by residents. Am J Obstet Gynecol. 2005 May;192(5):1407–9. https://doi.org/10.1016/j.ajog.2004.10.605
25. Goetzinger KR, Odibo AO, Shanks AL, Roehl KA, Cahill AG. Clinical accuracy of estimated fetal weight in term pregnancies in a teaching hospital. J Matern Fetal Neonatal Med. 2014;27(1):89–93. https://doi.org/10.3109/14767058.2013.782526
26. Gull I, Fait G, HarToov J, et al. Prediction of fetal weight by ultrasound: the contribution of additional examiners. Ultrasound Obstet Gynecol. 2002 Jan;20(1):57–60. https://doi.org/10.1046/j.1469-0705.2002.00531.x
27. Melamed N, Yogev Y, Meizner I, Mashiach R, BenHaroush A. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med. 2010 Feb;29(2):225–30. https://doi.org/10.7863/jum.2010.29.2.225
2. Valsky DV, Lipschuetz M, Bord A, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by threedimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009 Jul;201(1):91.e17. https://doi.org/10.1016/j.ajog.2009.03.028
3. Elvander C, Högberg U, Ekeus C. The influence of fetal head circumference on labor outcome: a populationbased register study. Acta Obstet Gynecol Scand. 2012 Apr;91(4):470–5. https://doi.org/10.1111/j.1600-0412.2012.01358.x
4. Lipschuetz M, Cohen SM, EinMor E, et al. A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol. 2015 Aug;213(2):833.e112. https://doi.org/10.1016/j.ajog.2015.05.012
5. De Vries B, Bryce B, Zandanova T, et al. Is neonatal head circumference related to caesarean section for failure to progress? Aust N Z J Obstet Gynaecol. 2016 Dec;56(6):5717. https://doi.org/10.1111/ajo.12565
6. Lipschuetz M, Cohen M, Baron J, et al. Sonographic large fetal head circumference and risk of cesarean delivery. Am J Obstet Gynecol. 2018 Mar;218(3):339.e17. https://doi.org/10.1016/j.ajog.2017.11.591
7. Ooi PV, Ramphul M, Said S, et al. Ultrasound assessment of fetal head circumference at the onset of labor as a predictor of operative delivery. J Matern Fetal Neonatal Med. 2015 Sep;28(18):21826. https://doi.org/10.3109/14767058.2014.993949
8. Aviram A, Yogev Y, Bardin R, et al. Association between sonographic measurements of fetal head circumference and labor outcome. Int J Gynaecol Obstet. 2016 Jan;132(1):72–6. https://doi.org/10.1016/j.ijgo.2015.06.011
9. Rostaminia G, Peck JD, Van Delft K, et al. New measures for predicting birthrelated pelvic floor trauma. Female Pelvic Med Reconstr Surg. 2016 Sep;22(5):292–6.
10. Rabei NH, ElHelaly AM, Farag AH, et al. Intrapartum fetal head circumference and estimated fetal weight as predictors of operative delivery. Int J Obstet Gynecol. 2017 Jan;137(1):34–9. https://doi.org/10.1002/ijgo.12007
11. Burke N, Burke G, Breathnach F, et al. Prediction of cesarean delivery in the term nulliparous woman: Results from the prospective, multicenter Genesis study. Am J Obstet Gynecol. 2017 Jun;216(6):598.e1–e8. https://doi.org/10.1016/j.ajog.2017.02.013
12. Guerby P, Parent O, Vayssiere C, et al. Comment on: Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study. Fetal Diagn Ther. 2018;43(2):160–1. https://doi.org/10.1159/000486783
13. Yagel O, Cohen SM, Lipschuetz M, et al. Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study. Fetal Diagn Ther. 2017;42(4):289–94. https://doi.org/10.1159/000478010
14. Kabiri D, Lipschuetz M, Cohen SM, et al. Vacuum extraction failure is associated with a large head circumference. J Matern Fetal Neonatal Med. 2018;31(9):1162–7. https://doi.org/10.1080/14767058.2017.1277717
15. Lipschuetz M, Cohen SM, Lewkowicz D, et al. Prolonged second stage of labor: causes and outcomes. Harefuah. 2018 Nov;157(11):685–90.
16. Rizzo G, Aiello E, Bosi C, et al. Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand. 2017 Jul;96(7):1006–11. https://doi.org/10.1111/aogs.13189
17. Elgarhy IT, Sabry NM, Abdelkader HM, et al. The influence of fetal head circumference and fetal weight assessed by intrapartum ultrasound on labor outcome. Egypt J Hosp Med. 2019 Aug;74(8):1785–90.
18. Larson A, Mandelbaum DE. Association of head circumference and shoulder dystocia in macrosomic neonates. Matern Child Health J. 2013 Mar;17(3):501–4. https://doi.org/10.1007/s10995-012-1013-x
19. Kjaergaard H, Olsen J, Ottesen B, Nyberg P, Dykes AK. Obstetric risk indicators for labor dystocia in nulliparous women: a multicentre cohort study. BMC Pregnancy Childbirth. 2008 Sep;8:45. https://doi.org/10.1186/1471-2393-8-45
20. Mujugira A, Osoti A, Deya R, Hawes SE, Phipps AI. Fetal head circumference, operative delivery, and fetal outcomes: a multiethnic populationbased cohort study. BMC Pregnancy Childbirth. 2013 Jun;13:106. https://doi.org/10.1186/1471-2393-13-106
21. Groutz A, Hasson J, Wengier A, et al. Third and fourthdegree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol. 2011 Apr;204(4):347.e1–4. https://doi.org/10.1016/j.ajog.2010.11.030
22. Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum hemorrhage in nulliparous women: incidence and risk factors in low and high risk women. A Dutch populationbased cohort study on standard and severe postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004 Jun;115(2):166–72. https://doi.org/10.1016/j.ejogrb.2003.10.010
23. Fuchs F, Bouyer J, Rozenberg P, Senat MV. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birthweight? BMC Pregnancy Childbirth. 2013 May;13:90. https://doi.org/10.1186/1471-2393-13-90
24. Noumi G, Collado-Khoury F, Bombard A, Julliard K, Weiner Z. Clinical and sonographic estimation of fetal weight performed during labor by residents. Am J Obstet Gynecol. 2005 May;192(5):1407–9. https://doi.org/10.1016/j.ajog.2004.10.605
25. Goetzinger KR, Odibo AO, Shanks AL, Roehl KA, Cahill AG. Clinical accuracy of estimated fetal weight in term pregnancies in a teaching hospital. J Matern Fetal Neonatal Med. 2014;27(1):89–93. https://doi.org/10.3109/14767058.2013.782526
26. Gull I, Fait G, HarToov J, et al. Prediction of fetal weight by ultrasound: the contribution of additional examiners. Ultrasound Obstet Gynecol. 2002 Jan;20(1):57–60. https://doi.org/10.1046/j.1469-0705.2002.00531.x
27. Melamed N, Yogev Y, Meizner I, Mashiach R, BenHaroush A. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med. 2010 Feb;29(2):225–30. https://doi.org/10.7863/jum.2010.29.2.225
| Files | ||
| Issue | Vol 8 No 2 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Fetal Head Circumference (FHC) Estimated Fetal Weight (EFW) Cesarean Section Ultrasound in Pregnancy | ||
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How to Cite
1.
Sabzevary M, Shirazi M, Rahimi F, Golshahi F, Moghimi Z, Sobhanian E, Naderan M. The Effects of Fetal Head Circumference on The Duration of Labor and Cesarean Section in Term Pregnancy. AJS. 2025;8(2):61-66.
