Intrapartum Ultrasound in Maternal Lateral Position. A Prospective Observational Study (original) (raw)
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ISRN Obstetrics and Gynecology, 2014
Introduction. Recent evidence indicates that clinical examination, for determination of fetal head position, is subjective and inaccurate. Present study was aimed to compare transabdominal ultrasound for fetal head position with vaginal examination during first stage of labor. Material and Methods. This prospective study was performed at a tertiary center during a two-year period. Before or after clinically indicated vaginal examinations, transverse suprapubic transabdominal real-time ultrasound fetal head position assessment was done. Frequencies of various ultrasound depicted fetal head positions were compared with position determined at vaginal examination. Results. In only 31.5% of patients, fetal head position determinations by vaginal examinations were consistent with those obtained by ultrasound. Cohen’s Kappa test of concordance indicated a poor concordance of 0.15. Accuracy of vaginal examination increased to 66% when fetal head position at vaginal examination was recorded ...
Objective To test the null hypothesis that no correlation exists between transvaginal digital examination compared with the gold standard technique of transabdominal suprapubic ultrasound assessment of fetal head position during the second stage of labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound assessment. Methods Consecutive patients in the second-stage of labor at term with normal singleton cephalic-presenting fetuses and ruptured membranes were included. Transvaginal digital examinations were performed by either attending physicians or senior residents and were followed immediately by transverse suprapubic transabdominal sonographic assessments performed by a single sonographer. Examiners were blinded to each other's findings. Power analysis dictated sample size. Exact binomial confidence intervals around observed rates were compared with χ 2 and Cohen's κ-tests. Logistic regression was applied. P < 0.05 was considered significant throughout. Results One hundred and twelve patients were studied. The absolute error of transvaginal digital examinations was recorded in 65% of patients (95% confidence interval, 56-74%). Parity, pelvic station, combined spinal epidural anesthesia, length of first or second stages of labor, use of oxytocin augmentation, gestational age, mode of delivery, birth weight, and examiner experience did not significantly affect examination accuracy. Stratification, when the transvaginal digital examination was recorded as correct if occurring within ± 45° of the ultrasound assessment, reduced the error of the transvaginal digital examinations to 39% (95% confidence interval, 30 -49%). Independent variables again did not affect examination accuracy in this assessment modality. Rates of agreement between the two methods for attending physicians compared with residents were not significantly different. The overall degrees of agreement were 40% (95% confidence interval, 26-55%) and 68% (95% confidence interval, 53-80%) (κ = 0.25 and 0.30) for the absolute agreement and ± 45° assessment modalities, respectively, for attending physicians, and 31% (95% confidence interval, 20 -44%) and 55% (95% confidence interval, 42-68%) (κ = 0.14 and 0.12) for senior residents. Conclusion Using ultrasound assessment as the gold standard, our data demonstrate a high rate of error (65%) in transvaginal digital determination of fetal head position during the second stage of labor. The performance of senior residents in transvaginal digital examinations did not differ significantly from that of attending physicians. Intrapartum ultrasound increases the accuracy of fetal head position assessment during the second stage of labor.
Current health sciences journal, 2014
The main objective of this study was to observe the behavior of the fetal head position during labor, when starting from occiput anterior or posterior position and also to determine their importance in labor management (if the starting fetal head position can be a strong argument in favour of vaginal or cesarean delivery). 187 patients in labor were included in this study, with gestational age over 37 weeks and estimated fetal weight over 2500 g, singleton pregnancy, cephalic presentation, empty urinary bladder. For these patients the ultrasound assessed parameters were: fetal head position at the beginning of labour and fetal head rotation during labour. 89,18 percent of the patients starting from OTP (occiput transverse or posterior position) had a vaginal birth after an anterior rotation of the fetal head, and only 10,82 % presented persitent occiput posterior requiring cesarean section for delivery. Furthermore, considering only initial occiput posterior position, we observed an...
American Journal of Obstetrics and Gynecology, 2005
Objective: Precise determination of fetal head position in labor is a prerequisite for safe instrumental deliveries, and essential for the assessment of labor progress. Recent studies have cast serious doubts on the accuracy of the time-honored digital vaginal examination (DVE) in comparison to transabdominal ultrasound scans (TUS). However, transabdominal imaging is technically difficult with a deeply engaged fetal head in the second stage of labor. We examined the accuracy and time requirements of transvaginal scans (TVS) in the second stage of labor for determination of fetal head position. Study design: Sixty laboring women in the second stage of labor with a deeply engaged fetal head were examined by experienced nurse midwives and senior residents. Fetal head position was recorded as ''time on a 12-hour clock.'' Subsequently, TUS and TVS were independently performed by a skilled sonographer. Accuracy and time requirements for all 3 examinations were recorded. Results: Fetal head position could be determined in all cases by TVS, but not in 7 cases and 9 cases by DVE and TUS, respectively (P ! .03; P ! .008). A discrepancy of 60( or more between the DVE and TUS or TVS was found in 13/60 cases (21.7%) and 14/60 cases (23.3%), respectively. A R90( discrepancy was found in 9/60 cases (15%) and 12/60 cases (20%), respectively (P ! .02 for comparison of TUS and TVS). In 5 cases, the digital examination erroneously perceived an occiput posterior position as occiput anterior. No significant differences in fetal head position were detected between TUS and TVS, when the examination was technically feasible. The mean time (GSD) required for determining fetal head position was shortest for TVS (8.7 G 5.8 seconds) in comparison to DVE (22.7 G 14.6 seconds; P ! .0001) or TAS (31.7 G 19.1 seconds; P ! .0001).
Ultrasound in Obstetrics and Gynecology, 2009
K E Y W O R D S: fetus; operative delivery; prenatal diagnosis; second stage of labor; translabial ultrasound ABSTRACT Objective To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor. Methods Patients with uncomplicated pregnancies at term gestation with fetuses in vertex presentation in the second stage of labor underwent serial translabial sonography and digital examinations. In a sagittal section of the maternal pelvis, the direction of the head was noted and categorized as downward, horizontal or upward. By rotating the transducer in the transverse plane the cerebral midline echo was also visualized and the rotation of the head was noted. Clinical and ultrasound data were compared using Somer's d-test. Results Sixty patients underwent a total of 168 clinical and sonographic examinations. When on the sonogram the fetal head was directed downward, the station assessed clinically was most frequently ≤ +1 cm from the ischial spines (44/57 (77.2%) cases); when the direction was horizontal, the station was most frequently ≤ +2 cm (53/59 (89.8%) cases); when the fetal head was directed upward, the station was usually ≥ +3 cm (46/52 (88.5%) cases). Failure to visualize the cerebral midline or a rotation ≥ 45 • were associated with a station of +2 cm or less in 98/103 (95.1%) examinations. Conversely, a rotation of < 45 • was associated with a station of +3 cm or more in 45/65 (69.2%) examinations. All comparisons between clinical and sonographic findings demonstrated a statistically significant relationship (P < 0.0001). The probability of a station +3 cm or more was particularly high when an upward direction of the head was seen in combination with a rotation of < 45 • (40/42 (95.2%) examinations). The interobserver variability (Cohen's kappa 0.795 and 0.727 for station and rotation, respectively; P < 0.001) and intraobserver variability (0.845 for both station and rotation, P < 0.001) suggested good reproducibility of the method.
Vertical Maternal Positions during Parturition in the Second Stage of Labor: A Scoping Review
Journal of South Asian Federation of Obstetrics and Gynaecology, 2024
The comfort level of the laboring mother is greatly affected by her choice of delivery position. The fact that giving birth is often difficult has a profound effect on women's satisfaction with both the experience itself and the care they get. Different birthing positions are available to a pregnant woman at the time of delivery. Currently, most births occur with the mother resting on her back or sitting up in an almost-seated position. Birthing in an upright posture is less common than lying on one's side, on one's back, or on one's hands and knees. The optimal posture for women to be in during the second stage of labor is not well supported by research. The purpose of this article was to assess the level of knowledge about various birthing positions among pregnant women and to evaluate the benefits and hazards of the most frequently used birthing positions.
2021
Purpose To determine the validity of Intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. Methods Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3hours ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descend, measured by AOP change/hour (calculated from serial measurements) was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. Results Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) co...
The Egyptian Journal of Radiology and Nuclear Medicine, 2014
Aim of the work: To assess the clinical significance of transperineal ultrasound measurements, the angle of progression and the head progression distance in prediction of the mode of delivery in women with prolonged second stage of labor. Subjects and methods: 60 women with a live singleton fetus at full term who presented with prolonged second stage of labor were enrolled in our study. Transperineal ultrasound was used for determination of both angle of progression and head progression distance. We statistically analyzed the relationship between the ultrasound measurements and the different modes of delivery. Results: 32 women had spontaneous vaginal delivery, 13 women had assisted vaginal delivery using vacuum extraction and the remaining 15 women had a cesarean section. A statistically significant difference was found between the angle of progression and the mode of delivery, however there was no statistically significant difference between head progressive distance and different modes of delivery. The angle of head progression correlated with the mode of delivery using logistic regression analysis with a probability of 85.5% for an angle of 120°.
Ultrasound assessment of fetal head-perineum distance before induction of labor
Ultrasound in Obstetrics and Gynecology, 2008
Objectives To evaluate fetal head-perineum distance measured by ultrasound imaging as a predictive factor for induction of labor, and to compare this distance with maternal factors, the Bishop score and ultrasound measurements of cervical length, cervical angle and occiput position.