Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control
<b>Objectives:</b> To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. <b>Methods:</b> Eighteen 3-dimensional (3D) volumes of transperinea...
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2025-07-01
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| Online Access: | https://www.mdpi.com/2075-4418/15/14/1757 |
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| author | Ana M. Fidalgo Adriana Aquise Francisca S. Molina Aly Youssef Otilia González-Vanegas Elena Brunelli Ilaria Cataneo Maria Segata Marcos J. Cuerva Valeria Rolle Maria M. Gil |
| author_facet | Ana M. Fidalgo Adriana Aquise Francisca S. Molina Aly Youssef Otilia González-Vanegas Elena Brunelli Ilaria Cataneo Maria Segata Marcos J. Cuerva Valeria Rolle Maria M. Gil |
| author_sort | Ana M. Fidalgo |
| collection | DOAJ |
| description | <b>Objectives:</b> To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. <b>Methods:</b> Eighteen 3-dimensional (3D) volumes of transperineal US from women at 36–40 weeks of gestation with a singleton fetus in breech presentation were provided to eight operators from four maternity units in Spain and Italy. All operators measured the BPA using 3D US volume processing software, and interobserver reproducibility was evaluated using the intraclass correlation coefficient (ICC). Following an online live review of all measurements by the operators, and the identification of sources of disagreement, an image-based scoring system for BPA measurement was collaboratively developed. The checklist included the following: (1) acquisition in the midsagittal plane, avoiding the posterior shadow of the pubic ramus; (2) visualization of the complete “almond-shaped” pubic symphysis; (3) drawing a first line along the longitudinal axis of the symphysis, dividing it equally; (4) extending this line to the inferior edge of the bone; and (5) drawing a second line tangentially from the lower edge of the symphysis to the lowest recognizable fetal part. The BPA measurements were then repeated using this checklist, and reproducibility was reassessed. <b>Results:</b> Eighteen volumes were analyzed by the eight operators, achieving a moderate reproducibility (ICC: 0.70, 95% confidence interval (CI): 0.48 to 0.86). A score was developed to include a series of landmarks for the appropriate assessment of BPA. Subsequently, the same eighteen volumes were reassessed using the new score, resulting in improved reproducibility (ICC: 0.81, 95% CI: 0.66 to 0.92). <b>Conclusions:</b> The measurement of BPA is feasible and reproducible when using a standardized image-based score. |
| format | Article |
| id | doaj-art-afd7524f605e48a6941f8512e72e8e22 |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-afd7524f605e48a6941f8512e72e8e222025-08-20T03:58:26ZengMDPI AGDiagnostics2075-44182025-07-011514175710.3390/diagnostics15141757Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality ControlAna M. Fidalgo0Adriana Aquise1Francisca S. Molina2Aly Youssef3Otilia González-Vanegas4Elena Brunelli5Ilaria Cataneo6Maria Segata7Marcos J. Cuerva8Valeria Rolle9Maria M. Gil10Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, 28850 Madrid, SpainDepartment of Obstetrics and Gynecology, Hospital Universitario de Torrejón, 28850 Madrid, SpainDepartment of Obstetrics and Gynecology, Hospital Universitario San Cecilio, 18016 Granada, SpainObstetrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Obstetrics and Gynecology, Hospital Universitario San Cecilio, 18016 Granada, SpainObstetrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyUOC Ginecologia ed Ostetricia, Ospedale Maggiore Bologna, 40133 Bologna, ItalyUOC Ginecologia ed Ostetricia, Ospedale Maggiore Bologna, 40133 Bologna, ItalyDepartment of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, SpainStatistics and Data Management Unit, iMaterna Foundation, Alcalá de Henares, 28806 Madrid, SpainDepartment of Obstetrics and Gynecology, Hospital Universitario de Torrejón, 28850 Madrid, Spain<b>Objectives:</b> To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. <b>Methods:</b> Eighteen 3-dimensional (3D) volumes of transperineal US from women at 36–40 weeks of gestation with a singleton fetus in breech presentation were provided to eight operators from four maternity units in Spain and Italy. All operators measured the BPA using 3D US volume processing software, and interobserver reproducibility was evaluated using the intraclass correlation coefficient (ICC). Following an online live review of all measurements by the operators, and the identification of sources of disagreement, an image-based scoring system for BPA measurement was collaboratively developed. The checklist included the following: (1) acquisition in the midsagittal plane, avoiding the posterior shadow of the pubic ramus; (2) visualization of the complete “almond-shaped” pubic symphysis; (3) drawing a first line along the longitudinal axis of the symphysis, dividing it equally; (4) extending this line to the inferior edge of the bone; and (5) drawing a second line tangentially from the lower edge of the symphysis to the lowest recognizable fetal part. The BPA measurements were then repeated using this checklist, and reproducibility was reassessed. <b>Results:</b> Eighteen volumes were analyzed by the eight operators, achieving a moderate reproducibility (ICC: 0.70, 95% confidence interval (CI): 0.48 to 0.86). A score was developed to include a series of landmarks for the appropriate assessment of BPA. Subsequently, the same eighteen volumes were reassessed using the new score, resulting in improved reproducibility (ICC: 0.81, 95% CI: 0.66 to 0.92). <b>Conclusions:</b> The measurement of BPA is feasible and reproducible when using a standardized image-based score.https://www.mdpi.com/2075-4418/15/14/1757breech presentationreproducibilitytransperineal ultrasoundintrapartum ultrasoundcephalic external version |
| spellingShingle | Ana M. Fidalgo Adriana Aquise Francisca S. Molina Aly Youssef Otilia González-Vanegas Elena Brunelli Ilaria Cataneo Maria Segata Marcos J. Cuerva Valeria Rolle Maria M. Gil Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control Diagnostics breech presentation reproducibility transperineal ultrasound intrapartum ultrasound cephalic external version |
| title | Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control |
| title_full | Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control |
| title_fullStr | Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control |
| title_full_unstemmed | Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control |
| title_short | Reproducibility of Breech Progression Angle: Standardization of Transperineal Measurements and Development of Image-Based Checklist for Quality Control |
| title_sort | reproducibility of breech progression angle standardization of transperineal measurements and development of image based checklist for quality control |
| topic | breech presentation reproducibility transperineal ultrasound intrapartum ultrasound cephalic external version |
| url | https://www.mdpi.com/2075-4418/15/14/1757 |
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