Fetal head position during the second stage of labor: comparison of digital vaginal examination and transabdominal ultrasonographic examination.
ABSTRACT To study the correlation between digital vaginal and transabdominal ultrasonographic examination of the fetal head position during the second stage of labor.
Patients (n = 110) carrying a singleton fetus in a vertex position were included. Every patient had ruptured membranes and a fully dilated cervix. Transvaginal examination was randomly performed either by a senior resident or an attending consultant. Immediately afterwards, transabdominal ultrasonography was performed by the same sonographer (OD). Both examiners were blind to each other's results. Sample size was determined by power analysis. Confidence intervals around observed rates were compared using chi-square analysis and Cohen's Kappa test. Logistic regression analysis was performed.
In 70% of cases, both clinical and ultrasound examinations indicated the same position of the fetal head (95% confidence interval, 66-78). Agreement between the two methods reached 80% (95% CI, 71.3-87) when allowing a difference of up to 45 degrees in the head rotation. Logistic regression analysis revealed that gestational age, parity, birth weight, pelvic station and examiner's experience did not significantly affect the accuracy of the examination. Caput succedaneum tended to diminish (p = 0.09) the accuracy of clinical examination. The type of fetal head position significantly affected the results. Occiput posterior and transverse head locations were associated with a significantly higher rate of clinical error (p = 0.001).
In 20% of the cases, ultrasonographic and clinical results differed significantly (i.e., >45 degrees). This rate reached 50% for occiput posterior and transverse locations. Transabdominal ultrasonography is a simple, quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor.
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ABSTRACT: Objective To evaluate if ultrasound determined occipito-transverse position early in the second stage of labor is associated with operative delivery.DesignRetrospective review of two prospective cohort studies.SettingAn Australian tertiary referral hospital.PopulationWomen with term, cephalic singleton pregnancies.Methods Retrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito-transverse position to operative delivery.Main outcome measureOperative delivery (cesarean section, forceps or vacuum extraction). ResultsAmong 422 women included. the occipito-transverse position was present in 80, occipito-anterior in 303 and the occipito-posterior in 39. Compared with occipto-anterior, the adjusted odds ratio for operative delivery was 2.1 (95% CI 1.2- 3.8, p = 0.02) for the occipito-transverse position, and 7.4 (95% CI 3.2-17) for the occipito-posterior position. Factors which independently predicted operative delivery were nulliparity, abnormal second stage, abnormal cardiotocography, maternal place of birth and epidural analgesia. The length of second stage of labor was longer for the occipito-transverse group than for the occipito-anterior group (median 2 hours 7 mins vs. 1 hour 36 mins p=0.003).Conclusion The occipito-transverse position early in second stage of labor was associated with an increased operative delivery rate.This article is protected by copyright. All rights reserved.Acta Obstetricia Et Gynecologica Scandinavica 07/2014; · 1.85 Impact Factor
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ABSTRACT: 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 correct if reported within +45° of the ultrasound assessment. Rate of agreement between the two assessment methods for consultants versus residents was 36% and 26%, respectively (P = 0.17). Conclusion. We found that vaginal examination was associated with a high error rate in fetal head position determination. Data supports the idea that intrapartum transabdominal ultrasound enhances correct determination of fetal head position during first stage of labor.ISRN obstetrics and gynecology 01/2014; 2014:314617.
Article: Role of ultrasound on the labor ward[Show abstract] [Hide abstract]
ABSTRACT: Ultrasound is an important investigational tool used in the antenatal period, and is increasingly being used in labor and the peripartum period. Research over the past two decades has focused on establishing objective ultrasound parameters to define fetal gestational age/estimated fetal weight in labor, to identify fetuses at risk of compromise in labor, to predict mode of delivery and to enhance the safety of operative deliveries. This review outlines the role of these various uses of ultrasound and explores whether there may be a role for routine use of ultrasound in the management of labor and delivery.Expert Review of Obstetrics & Gynecology 01/2014; 7(6).