280
head station’, developed by Tutschek et al.2 . This method
Fetal head station: myth of ACOG classification
We thank Dr Tutschek and colleagues for their interest in
our work and for the new data they provide. Among the
many sonographic methods proposed to date to evaluate
fetal head descent, some measure a distance, while others
measure an angle1 . The premise of our work was indeed
the method ‘intrapartum transperineal ultrasound (ITU)
Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Correspondence
is appealing because it combines the assessment of two
parameters: head extension and progression of the head
beyond the ischial spines. As ITU head station is measured
in the long axis of the head, and not horizontally on the
image, it also takes into account changes in the angle of
direction of the fetal head in the pelvis2,3 . Like Tutschek
et al., we believe that the angle of direction has been
underestimated until now. In the labor ward, the head
direction is more difficult to evaluate than is the angle of
progression (AoP), and head direction evaluation is often
reported in the literature as having been carried out offline.
However, this measure provides important information
about the risk of dystocia. The direct link between changes
in AoP, head direction and ITU head station now provides
a more complete understanding of cephalic descent. From
the perspective of wide application of these tools, we felt it
important to provide more robust data on the anatomical
relationship between the symphysis and the ischial spines,
and this has now been achieved. It is noteworthy that
anatomical and clinical studies produce similar values
of AoP and symphysis–spine distance, strengthening
support for the relevance of this ultrasound approach.
In contrast, the clinical classification proposed by the
American Congress of Obstetricians and Gynecologists
(ACOG) appears simplistic and poorly standardized4 ,
defining not a geometric plane of the ischial spines, but
only the ‘level of the ischial spines’. The clinical method
to assess the relationship between this ‘level of the ischial
spines’ and the top of the fetal head is not detailed by
ACOG5 . The poor reproducibility of clinical examination
is more likely to be due to imprecision in the description
of the method itself than to varying skills of practitioners.
Moreover, the ACOG classification does not reflect the
true trajectory of the fetal head. For these reasons, we
believe that it should be abandoned.
C. J. Arthuis*, F. Perrotin and E. G. Simon
University Hospital Center of Tours,
Department of Obstetrics, Gynecology and
Fetal Medicine, Tours, France;
Inserm U930, François–Rabelais University,
Tours, France
*Correspondence.
(e-mail: chloearthuis@gmail.com)
DOI: 10.1002/uog.17292
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