Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial

Seval, Mehmet Murat; Kalafat, Erkan; Duman, Berker; Aker, Seda Şahin; Kumbasar, Hakan; Koç, Acar

doi:10.1002/uog.15994

Cited by 40 publications

(29 citation statements)

References 16 publications

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“…Vaginal digital examination is neither highly reproducible nor reliable for determining cervical dilation and is a cause of intense emotional distress for many women during pregnancy and labor . In addition, digital vaginal examination is painful, and it has been demonstrated that transperineal ultrasound is less bothersome …”

Section: Discussionmentioning

confidence: 99%

“…In addition, digital vaginal examination is poorly tolerated. This is evident when comparing the pain produced by digital vaginal examination with the pain produced by transperineal ultrasound …”

Section: Introductionmentioning

confidence: 99%

“…This is evident when comparing the pain produced by digital vaginal examination with the pain produced by transperineal ultrasound. 9,10 It is important to assess the latent phase of labor accurately. Given the poor reliability and pain associated with digital vaginal examination, an alternative has been suggested by the use of intrapartum ultrasound (ITU) to measure cervical dilation, fetal head station, fetal head position, caput, and molding in a sonopartogram.…”

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confidence: 99%

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Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

Cuerva

García-Casarrubios

García-Calvo

et al. 2018

Acta Obstet Gynecol Scand

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Introduction The aim of this study was to test the hypothesis that transperineal ultrasound can be used to decide whether to admit a pregnant woman due to labor. Material and methods In this analytical cross‐sectional observational study, transperineal ultrasound was performed on pregnant women with intact membranes who came to the hospital due to contractions. A decision was made to admit women due to labor based on the ultrasound measurements. The ultrasound measurements were used to determine cervical dilation, the angle of progression, and fetal head position. The managing midwives were blinded to the results and made the final decision to admit the women based on digital vaginal examination. Results It was possible to decide whether a woman had to be admitted for delivery or discharged due to the latent phase of labor according to the ultrasound examination in 55 of the 57 cases (96.5%). In four of the 55 cases, the decision based on ultrasound differed from the midwife's decision (7.3%). There was strong agreement between the decision to admit the pregnant women based on ultrasound measurements and the digital vaginal examination (Cohen's kappa: 0.844). It was possible to measure cervical dilation with ultrasound in 52 of the 57 cases (91.2%). The intraclass correlation coefficient for the cervical dilation measurements was 0.736 (95% confidence interval 0.539‐0.848). Conclusions There was strong agreement between the ultrasound and digital vaginal examination results in the decision to admit singleton pregnant women at term due to labor. A large number of vaginal examinations could be avoided by using intrapartum ultrasound.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

Cuerva

García-Casarrubios

García-Calvo

et al. 2018

Acta Obstet Gynecol Scand

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“…A number of new techniques have been described using transperineal ultrasound to monitor labor progress through measurements relating fetal head position to the maternal pelvis 12,13 . These techniques are non-invasive, are well tolerated by patients and have a high degree of inter-and intraobserver reliability 8,[14][15][16][17][18][19][20][21][22][23] . The most widely studied measurement is that of the angle of progression (AoP), which is the angle between the leading part of the fetal skull and the maternal pubic symphysis 13 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Frick

Kostiv

Vojtassakova

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives First, to compare the manual sagittal and parasagittal and automated parasagittal methods of measuring the angle of progression (AoP) by transperineal ultrasound during labor, and, second, to develop models for the prediction of time to delivery and need for Cesarean section (CS) for failure to progress (FTP) in a population of patients undergoing induction of labor. Methods This was a prospective observational study of transperineal ultrasound in a cohort of 512 women with a singleton pregnancy undergoing induction of labor. A random selection of 50 stored images was assessed for inter‐ and intraobserver reliability of AoP measurements using the manual sagittal and parasagittal and automated parasagittal methods. In cases of vaginal delivery, univariate linear, multiple linear and quantile regression analyses were performed to predict time to delivery. Univariate and multivariate binomial logistic regression analyses were performed to predict CS for FTP in the first stage of labor. Results The intraclass correlation coefficient (ICC) for the manual parasagittal method for a single observer was 0.97 (95% CI, 0.95–0.98) and for two observers it was 0.96 (95% CI, 0.93–0.98), indicating good reliability. The ICC for the sagittal method for a single observer was 0.93 (95% CI, 0.88–0.96) and for two observers it was 0.74 (95% CI, 0.58–0.84), indicating moderate reliability for a single observer and poor reliability between two observers. Bland–Altman analysis demonstrated narrower limits of agreement for the manual parasagittal approach than for the sagittal approach for both a single and two observers. The automated parasagittal method failed to capture an image in 19% of cases. The mean difference in AoP measurements between the sagittal and manual parasagittal methods was 11°. In pregnancies resulting in vaginal delivery, 54% of the variation in time to delivery was explained in a model combining parity, epidural and syntocinon use during labor and the sonographic findings of fetal head position and AoP. In the prediction of CS for FTP in the first stage of labor, a model which combined maternal factors with the sonographic measurements of AoP and estimated fetal weight was superior to one utilizing maternal factors alone (area under the receiver‐operating‐characteristics curve, 0.80 vs 0.76). Conclusions First, the method of measuring AoP with the greatest reliability is the manual parasagittal technique and future research should focus on this technique. Second, over half of the variation in time to vaginal delivery can be explained by a model that combines maternal factors, pregnancy characteristics and ultrasound findings. Third, the ability of AoP to provide clinically useful prediction of CS for FTP in the first stage of labor is limited. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…In this group, the average angle obtained in vaginal deliveries was 141.6º (SD 14.8, improve the comfort of the pregnant woman, compared to digital exploration [11]. Souka noted that assessment of fetal head position by digital examination, wich is dependent and poorly reproducible by another operator, was not possible in 61% of cases in the first stage and 31% in the second stage of labor [12].…”

Section: Spontaneous Vaginal Delivery Occurred In 72 (71%) Women Insmentioning

confidence: 99%

Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

Pérez¹,

Seguer²,

Pujadas³

et al. 2017

Clin Obstet Gynecol Reprod Med

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Objective: The aim of this study was to investigate the role of the 'angle of progression' (AOP) in the prediction of vaginal delivery and establish a cut-off value.Method: 101 pregnant women were included in this prospective study. They were admitted in labor to our hospital and had singleton cephalic presentations and full-term pregnancies. AOP was measured at admission time. We analyzed the results of all the women included but also a subgroup of 66 singleton pregnant women whose assessment of the AOP was performed at the beginning of the second stage of labor.Results: Ninety-one patients had a vaginal delivery (90%) and 19 a cesarean section (10%).The area under the curve was 0.85 (95% confidence interval [CI], 0.77-0.92)and the value of the AOP that optimizes the curve was 125º (S 67.1% E 100%). In the subgroup that was assessed at the second stage of labor, the area under the curve was 0.97 (95%CI,0.90-0.99) and a value of the AOP that optimizes the curve was also 125º (S 91.38% E 100%). Conclusions:The angle of progression is a simple and reliable intrapartum ultrasound parameter for the evaluation of fetal head descent. Transperineal ultrasound assessment could help to decide the method of delivery. In our experience, the sensitivity of the ultrasound measurement increases when this is taken in the second stage of childbirth.

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Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial

Cited by 40 publications

References 16 publications

Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

Comparison of different methods of measuring angle of progression in prediction of labor outcome

Role of intrapartum transperineal ultrasound: Angle of progression cut-off and correlation with delivery mode

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