No abstract

10/27 (37%); p=0.04. In OA positions the molding was seen as occipito-parietal molding in 68/69 cases, and as parieto-parietal molding in one case with deflexed attitude. Molding was seen in 19/38 (50%) of OA positions ending with spontaneous delivery, 42/71(59%) ending with vacuum extraction and in 7/8 (88%) with failed vacuum extraction (p=0.13). In four fetuses with OP positions parieto-parietal molding was diagnosed and successful vacuum extraction occurred in three cases and failed extraction in one. Fronto-parietal molding was seen in two transverse positions and four posterior positions. One delivered spontaneously, vacuum extraction failed in three cases and was successful in one. Only 1/1l fetuses with either parieto-parietal or fronto-parietal molding delivered spontaneously. ConclusionThe different types of molding can be classified with ultrasound. Occipitoparietal molding was commonly seen in OA positions and not significantly associated with delivery mode. Fronto-parietal and parieto-parietal molding were less frequent than reported in old studies.

Objectives: Exact knowledge of fetal station and position is of paramount importance for reliable surveillance of labor progress and a prerequisite for safe operative vaginal procedures. Detailed clinical assessments are thoroughly described in old textbooks, but almost forgotten in contemporary obstetrics. Ultrasound is suggested as an objective diagnostic tool in active labor. Several publications have demonstrated a low correlation between ultrasound and clinical assessment of fetal head station and position, but the methods of clinical assessment in these studies are poorly described. We wanted to explore if a quality clinical assessment could perform better than clinical assessment in previous publications, by analysing the correlation between a structured method of clinical assessment and intrapartum ultrasound.Methods: In all, 100 laboring women with cervical dilatation ≥7 cm were included in a prospective cohort study at Oslo University Hospital from October to December 2016. The study design was cross sectional. Clinical examinations were performed by one special educated consultant (JKI), and transabdominal and transperineal ultrasound clips were recorded and examined by a blinded expert in intrapartum ultrasound (TME). Fetal position was classified as a clock face with 12 units (hourly divisions) and thereafter categorized as occiput anterior (OA), left occiput transverse (LOT), occiput posterior (OP) and right occiput transverse (ROT) positions. Fetal station was categorized clinically from -5 to + 5 and measured with ultrasound as angle of progression (AoP) and head-perineum distance (HPD).AoP is the angle between a longitudinal line through the symphysis and a tangent to the head contour. HPD is the shortest distance between the fetal skull and the perineum.Results: Eight women were excluded due to strong contractions between clinical assessments and ultrasound measurements, fetal distress or incomplete examinations. Fetal position assessed by ultrasound and clinical examination agreed exactly in 48/92 (52%) cases, within one unit (hour) in 87/92 (95%) of cases and within two units in 90/92 (98%) of cases.It differed by three units in one case and by five units in one case. The agreement categorized into OA, LOT, OP and ROT was good (Cohen's kappa 0.72; 95% CI 0.61-0.84). For station, the agreement was very good for both head-perineum distance (Pearson correlation coefficient r=0.86; 95% CI 0.80-0.91) and angle of progression (r=0.77; 95% CI to 0.67-0.84). The correlation between HPD and AoP was good (r =0.76; 95% CI 0.65-0.84). Conclusion:We found very good correlations between structured clinical assessments and ultrasound examinations, suggesting that an objective quality in clinical examinations is possible to achieve. More focus on clinical skills training may improve accuracy for clinicians.