Comparative Study of Ultrasound with Transvaginal Finger Examination in Diagnosis of Abnormal Position and Presentation of Fetal Head

Background: Abnormal position and presentation are challenges for obstetricians in about 10% of all pregnancies. Objectives: The purpose of this study was to compare ultrasound with transvaginal finger examination in detecting abnormal position and presentation of fetal head. Methods: This was a cross-sectional study performed in Ali ibn-e Abitaleb Hospital of Zahedan in 2018. The women underwent vaginal finger examination in the first phase of delivery, and then trans-abdominal ultrasound was performed for pregnant women. All examinations and ultrasounds were performed by one person with the same ultrasound device. Data were analyzed with SPSS software. Results: In this study, 100 pregnant women were studied in the first phase of pregnancy. The mean age of the subjects was 24.7 ± 5.5 years old. Fetal head position was determined in 81 and 93% of women with vaginal examination and ultrasound, respectively. There was weak agreement (kappa = 0.416). Fetal presentation was determined by finger examination in 93% of cases and by ultrasound in 100% of cases. There was moderate agreement (kappa = 0.783). Conclusions: In general, the results of this study showed that there was no significant difference between ultrasound and finger examination in the presentation and position of fetal head.

Sonographic Evaluation of the Mechanism of Active Labor (SonoLabor Study): observational study protocol regarding the implementation of the sonopartogram

IntroductionOver the last decades, a large body of literature has shown that intrapartum clinical digital pelvic estimations of fetal head position, station and progression in the pelvic canal are less accurate, compared with ultrasound (US) scan. Given the increasing evidence regarding the advantages of using US to evaluate the mechanism of labour, our study protocol aims to develop sonopartograms for fetal cephalic presentations. They will allow for a more objective evaluation of labour progression than the traditional labour monitoring, which could enable more rapid decisions regarding the mode of delivery.Methods/analysisThis is a prospective observational study performed in three university hospitals, with an unselected population of women admitted in labour at term. Both clinical and US evaluations will be performed assessing fetal head position, descent and rotation. Specific US parameters regarding fetal head position, progression and rotation will be recorded to develop nomograms in a similar way that partograms were developed. The primary outcome is to develop nomograms for the longitudinal US assessment of labour in unselected nulliparous and multiparous women with fetal cephalic presentation. The secondary aims are to assess the sonopartogram differences in occiput anterior and posterior deliveries, to compare the labour trend from our research with the classic and other recent partogram models and to investigate the capability of the US labour monitoring to predict the outcome of spontaneous vaginal delivery.Ethics and disseminationAll protocols and the informed consent form comply with the Ministry of Health and the professional society ethics guidelines. University ethics committees approved the study protocol. The trial results will be published in peer-reviewed journals and at the conference presentations. The study will be implemented and reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement.Trial registration numberClinicalTrials.gov Registry (NCT02326077).

The Comparison of Intrapartum Sonographic Signs and Digital Examination in Fetus with Cephalic Presentation

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