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

Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.

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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

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7049 ◽

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.

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