Correlation of Digital Vaginal Examination with Transabdominal Ultrasound to Assess Fetal Head Position during Active Labor

Objective: The agreement of fetal head position examined by digital vaginal examination (DVE) and intrapartum sonographic signs (ISS) in pregnant women during labor. Materials and Methods: A cross-sectional study was conducted. Two hundred eight-term singleton pregnant women attending labor at Ramathibodi Hospital, Thailand with the fetal cephalic presentation, cervical dilatation of 4 to 8 cm, station –2 or below and no contraindication for DVE were enrolled. The DVE evaluating fetal head position was performed by the third-year obstetrical residents. After DVE, ISS via transabdominal ultrasound for determining fetal head position was obtained immediately by the first researcher. The DVE report and the ultrasonographic images of ISS were recorded separately. The fetal head position based on ISS was designated by the second researcher blinded to the DVE result. The agreement of DVE and ISS for determining fetal head position was analyzed. Results: Two hundred eight pregnant women were analyzed. The fetal head position detected by DVE was consistent with that of ISS at 41.3% (p<0.001). The most percent agreement was observed in the fetus with left occiput anterior position at 72.7% (p<0.001). The lowest percent agreement was found in the direct occiput posterior at 14.3% (p=0.243). Parity, gestational age, current body mass index, epidural analgesia, cervical effacement, caput succedaneum, molding, and station did not significantly affect the discrepancy between DVE and ISS. Conclusion: The agreement between DVE and ISS for evaluating the fetal head position was low. The ISS might be considered for evaluating the fetal head position. Keywords: Fetal head position, Intrapartum sonographic sign, Digital vaginal examination

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Fetal Head Position during the First Stage of Labor: Comparison between Vaginal Examination and Transabdominal Ultrasound

ISRN Obstetrics and Gynecology ◽

10.1155/2014/314617 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Jyothi Shetty ◽

Vinod Aahir ◽

Deeksha Pandey ◽

Prashanth Adiga ◽

Asha Kamath

Keyword(s):

Head Position ◽

Transabdominal Ultrasound ◽

Vaginal Examination ◽

Fetal Head ◽

Kappa Test ◽

Tertiary Center ◽

Correct Determination ◽

Fetal Head Position ◽

First Stage Of Labor

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.

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