OC08.09: Impact of transperineal ultrasound to assess fetal head descent on obstetrical interventions at full cervical dilatation

2009 ◽  
Vol 34 (S1) ◽  
pp. 15-15
Author(s):  
A. Dückelmann ◽  
S. A. Michaelis ◽  
C. Bamberg ◽  
J. Lange ◽  
A. Nonnenmacher ◽  
...  
Keyword(s):  
Transperineal Ultrasound ◽  
Cervical Dilatation ◽  
Fetal Head ◽  
Obstetrical Interventions

Feasibility, Reliability, and Agreement of Transperineal Ultrasound Measurement: Results from a Longitudinal Cohort Study

2020 ◽  
Vol 47 (10) ◽  
pp. 721-730
Author(s):  
Angel H.W. Kwan ◽  
Piya Chaemsaithong ◽  
Wing Ting Tse ◽  
Kubi Appiah ◽  
Ka Chun Chong ◽  
...  
Keyword(s):  
Transperineal Ultrasound ◽  
Cervical Dilatation ◽  
Ultrasound Measurement ◽  
Vaginal Examination ◽  
Fetal Head ◽  
Prospective Longitudinal Study ◽  
Measurement Results ◽  
High Measurement ◽  
Prospective Longitudinal ◽  
Singleton Pregnancies

<b><i>Objectives:</i></b> To evaluate the feasibility, reliability, and agreement of serial transperineal ultrasound (TPU) assessment of fetal head station (parasagittal angle of progression [psAOP], head-perineum distance [HPD], and head-symphysis distance [HSD]) and sonographic cervical dilatation (SCD), compared to fetal head station and cervical dilatation determined by vaginal examination, respectively. <b><i>Methods:</i></b> This was a prospective longitudinal study in singleton pregnancies undergoing induction of labor at term. Paired assessment of fetal head station and cervical dilatation by vaginal examination, with TPU assessment of psAOP, HPD, HSD, and SCD was made serially. Feasibility, correlation, reliability, and agreement were determined. <b><i>Results:</i></b> 1,139 paired measurements among 326 women were included. psAOP and HPD were achievable in all assessments. HSD was not achievable in 3.4% (11/326) due to high fetal head station. Fetal head station by vaginal examination was positively correlated with psAOP (rho = 0.70) but negatively correlated with HPD (rho = −0.57) and HSD (rho = −0.52). The feasibility to measure SCD reduced as cervical dilatation increased. Cervical dilatation and SCD were positively correlated (rho = 0.96) with strong agreement (concordant correlation coefficient = 0.925). <b><i>Conclusions:</i></b> Measurements of psAOP and HPD are feasible and correlate significantly with fetal head station by vaginal examination. Measurement of HSD is not feasible when fetal head station is high. Measurement of SCD is feasible, but it is more difficult in the advanced stage of labor. The correlation, reliability, and agreement between SCD and cervical dilatation by vaginal examination are high.

scholarly journals Prediction of vaginal delivery with transperineal ultrasound in women induced with dinoprostone beyond 40 weeks of gestation

2018 ◽  
Vol 7 (8) ◽  
pp. 2998
Author(s):  
Hale Göksever Çelik ◽  
Engin Çelik ◽  
Gökhan Yıldırım
Keyword(s):  
Pregnant Women ◽  
Vaginal Delivery ◽  
Prospective Observational Study ◽  
Transperineal Ultrasound ◽  
Direct Visualization ◽  
Fetal Head ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
High Possibility ◽  
Angle Of Progression

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was greater in the multiparous women giving birth by vaginal route.Conclusions: Transperineal ultrasound can be applied at the beginning of labor to predict whether vaginal delivery will occur or not. As shown in our study, the pregnant women with shorter HPD and wider AOP might have a high possibility to achieve vaginal delivery.

scholarly journals 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

2021 ◽  
Vol 9 (B) ◽  
pp. 1037-1043
Author(s):  
Gamal Abdelsameea Ibrahim ◽  
Ahmed Soliman Nasr ◽  
Fatma Atta ◽  
Mohamed Reda ◽  
Hend Abdelghany ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Ultrasound Examination ◽  
Mode Of Delivery ◽  
Transperineal Ultrasound ◽  
Ultrasound Measurement ◽  
Vaginal Examination ◽  
Fetal Head ◽  
Prolonged Labor ◽  
Digital Vaginal Examination ◽  
Angle Of Progression

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 1st 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.

scholarly journals OP04.07: Three‐dimensional transperineal ultrasound render of fetal head in the second stage of labour: a pilot study

2019 ◽  
Vol 54 (S1) ◽  
pp. 97-97
Author(s):  
A. Youssef ◽  
M. Dodaro ◽  
G. Di Donna ◽  
L. Bianchini ◽  
F. Bellussi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Three Dimensional ◽  
Transperineal Ultrasound ◽  
Fetal Head ◽  
Second Stage ◽  
Second Stage Of Labour

Effect of Epidural Analgesia with Ambulation on Labor Duration

2001 ◽  
Vol 95 (4) ◽  
pp. 857-861 ◽  
Author(s):  
Manuel C. Vallejo ◽  
Leonard L. Firestone ◽  
Gordon L. Mandell ◽  
Francisco Jaime ◽  
Sandra Makishima ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Randomized Study ◽  
Mode Of Delivery ◽  
Vena Cava ◽  
Cervical Dilatation ◽  
Fetal Head ◽  
Chi Square ◽  
Labor Duration ◽  
Nulliparous Women ◽  
Scale Scores

Background Ambulatory epidural analgesia (AEA) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort, increases the intensity of uterine contractions, avoids inferior vena cava compression, facilitates fetal head descent, and relaxes the pelvic musculature, all of which can shorten labor. However, the preponderance of evidence suggests that ambulation during labor is not associated with these benefits. The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation. Methods In this prospective, randomized study, 160 nulliparous women with AFA were randomly assigned to one of two groups: AEA with ambulation and AEA without ambulation. AEA blocks were initiated with 15-20 ml ropivacaine (0.07%) plus 100 microg fentanyl, followed by a continuous infusion of 0.07% ropivacaine plus 2 microg/ml fentanyl at 15-20 ml/h. Maternal measured variables included ambulation time, time from epidural insertion to complete dilatation, stage II duration, pain Visual Analogue Scale scores, and mode of delivery. APGAR scores were recorded at 1 and 5 min. Results are expressed as mean +/- SD or median and analyzed using the t test, chi-square, or the Mann-Whitney test at P &lt; or = 0.05. Results The ambulatory group walked 25.0 +/- 23.3 min, sat upright 40.3 +/- 29.7 min, or both. Time from epidural insertion to complete dilatation was 240.9 +/- 146.1 min in the ambulatory group and 211.9 +/- 133.9 min in the nonambulatory group (P = 0.206). Conclusion Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation.

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