The Assessment of Intrapartum Transperineal Ultrasonographic Parameters for their Effectiveness in Evaluation of Progress of Labor and Prediction of Mode of Delivery in Egyptian Women

Gamal  Abdelsameea Ibrahim; Ahmed Soliman Nasr; Fatma Atta; Mohamed Reda; Hend Abdelghany; Nihal M. El-Demiry; Mohamed  Shalaby

doi:10.3889/oamjms.2021.7049

Authors

Gamal Abdelsameea Ibrahim Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt
Ahmed Soliman Nasr Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt
Fatma Atta Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt https://orcid.org/0000-0002-1002-0211
Mohamed Reda Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt https://orcid.org/0000-0002-0987-2134
Hend Abdelghany Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt https://orcid.org/0000-0002-0523-8793
Nihal M. El-Demiry Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt
Mohamed Shalaby Department of Obstetrics and Gynecology, Kasr el Ainy Faculty of Medicine, Cairo University, Giza, Egypt https://orcid.org/0000-0001-9009-2559

DOI:

https://doi.org/10.3889/oamjms.2021.7049

Keywords:

Labor, Intrapartum ultrasound, Angle of progression, Head perineal distance, Fetal head station, Digital vaginal examination

Abstract

Introduction: High fetal head station has been associated with prolonged labor and delivery outcomes. Although clinical assessment of fetal head station is both subjective and unreliable, women with prolonged labor are subjected to multiple digital vaginal examinations. The use of ultrasound has been proposed to aid in the management of labor since 1990s. Ultrasound examination is more accurate and reproducible than clinical examination in the diagnosis of fetal head station and in the prediction of arrest of labor. Ultrasound examination can, to some extent, distinguish those women destined for spontaneous vaginal delivery and those destined for operative delivery and may predict the outcome of instrumental vaginal delivery. Such a technique has the potential to reduce the frequency of intrusive internal examinations and associated infection and could be useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated. Intrapartum ultrasound not only provides objective and quantitative data in labor, but also helps to make more reliable clinical decisions aiming to improve obstetric outcomes of both the mother and fetus as a supplementary tool for active management.

Aim of the work: This study aims at assessing the value of intrapartum transperineal ultrasonography as a quantitative and objective tool in the evaluation of progress of labor and prediction of mode of delivery.

Subjects: This study was a prospective observational study conducted on 600 primiparous women in active first stage of labor admitted to Kasr Al Ainy maternity hospital from January 2017 to June 2018. The studied population was divided into two groups. Group A of 300 women with normal progress of labor and group B of 300 women with prolonged 1^st stage of labor. Methods: Fetal head station(FHS) was assessed clinically by digital vaginal examination (dVE) and sonographically by transperineal ultrasound measurement of head perineal distance (HPD) and angle of progression (AOP). Intrapartum care of the patient continued as normal based only on digital vaginal examinations using the modified WHO partogram. (1). Statistical analysis was targeted towards assessing the potential of the intrapartum ultrasonography in the evaluation of progress of labor and prediction of mode of delivery.

Results: All studied parameters for assessment of FHS (dVE, HPD, and AOP) significantly corelated with each other and with both progress of labor and mode of delivery with P value (<0.001). The highest sensitivity for prediction of progress of labor is observed using dVE (83%), the highest specificity is observed using AOP (78.3%). The highest sensitivity for prediction mode of delivery is for combined HPD & AOP (97.7%) while the highest specificity is for AOP (81%). When combining both HPD and AOP for prediction of mode of delivery, the assessment of both parameters was found to have a high sensitivity of 97.7% and a high positive predictive value of 86.63%.

Conclusion: Intrapartum ultrasound examination is a valuable tool in the prediction of progress of labor and mode of delivery. The assessment of fetal head station by transperineal ultrasound measurement of HPD and AOP is much more informative of the progress of labor and the mode of delivery than digital assessment of fetal head station.

Keywords: Labor, intrapartum ultrasound, Angle of progression, Head perineal distance, fetal head station, digital vaginal examination.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Williams JW, Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams Obstetrics; 2018.

Neal JL, Lowe NK. Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset. Med Hypotheses. 2012;78(2):319-26. http://doi.org/10.1016/j.mehy.2011.11.012 PMid:22138426 DOI: https://doi.org/10.1016/j.mehy.2011.11.012

Hassan WA, Eggebø T, Ferguson M, Gillett A, Studd J, Pasupathy D, et al. The sonopartogram: A novel method for recording progress of labor by ultrasound. Ultrasound Obstet Gynecol. 2014;43(2):189-94. http://doi.org/10.1002/uog.13212 PMid:24105734 DOI: https://doi.org/10.1002/uog.13212

Hjartardóttir H, Lund SH, Benediktsdóttir S, Geirsson RT, Eggebø TM. Fetal descent in nulliparous women assessed by ultrasound: A longitudinal study. Am J Obstet Gynecol. 2021;224(4):378.e1-15. PMid:33039395 DOI: https://doi.org/10.1016/j.ajog.2020.10.004

Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, et al. ISUOG Practice Guidelines: Intrapartum ultrasound. Ultrasound Obstet Gynecol. 2018;52(1):128-39. PMid:29974596 DOI: https://doi.org/10.1002/uog.19072

Gizzo S, Andrisani A, Noventa M, Burul G, Di Gangi S, Anis O, et al. Intrapartum ultrasound assessment of fetal spine position. Biomed Res Int. 2014;2014:783598. https://doi.org/10.1155/2014/783598. DOI: https://doi.org/10.1155/2014/783598

World Health Organization. Education material for teachers of midwifery. Midwifery Educ Modul. 2008;12:75.

Youssef A, Salsi G, Montaguti E, Bellussi F, Pacella G, Azzarone C, et al. Automated measurement of the angle of progression in labor: A feasibility and reliability study. Fetal Diagn Ther. 2017;41(4):293-9. http://doi.org/10.1159/000448947 PMid:27592216 DOI: https://doi.org/10.1159/000448947

Eggebø TM, Hassan WA, Salvesen KA, Lindtjørn E, Lees CC. Sonographic prediction of vaginal delivery in prolonged labor: A two-center study. Ultrasound Obstet Gynecol. 2014;43(2):195-201. http://doi.org/10.1002/uog.13210 PMid:24105705 DOI: https://doi.org/10.1002/uog.13210

Tutschek B, Torkildsen EA, Eggebø TM. Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor. Ultrasound Obstet Gynecol. 2013;41(4):425-9. http://doi/org/10.1002/uog.12422 PMid:23371409 DOI: https://doi.org/10.1002/uog.12422

Egypt Demographic and Health Survey 2014. Cairo, Egypt: Ministry of Health and Population and ICF International; 2015.

Wiafe YA, Whitehead B, Venables H, Nakua EK. The effectiveness of intrapartum ultrasonography in assessing cervical dilatation, head station and position: A systematic review and meta-analysis. Ultrasound. 2016;24(4):222-32. http://doi.org/10.1177/1742271X16673124 PMid:27847537 DOI: https://doi.org/10.1177/1742271X16673124