Intrapartum sonography – eccentricity or necessity?

Abstract

Ultrasonography has been extensively used in obstetrics and gynecology since 1980's. It found application in pediatric gynecology, procreation period, post-menopause, pregnancy monitoring and after delivery. Although the first reports on the use of ultrasonography in assessing delivery mechanism were published in 1990's, yet to date labor progress is evaluated by means of physical examination in most delivery units. Intrapartum sonography is not routinely performed despite the fact that numerous studies documented high error rates of conventional obstetrical examination. Even an experienced physician makes a mistake in every third case of the fetal head descent and fontanelle position assessment. Nowadays, obstetrician's role is not to strain for vaginal delivery at all costs, but to provide the patient in labor and her newborn with maximal safety. To achieve this objective, an obstetrician should distinguish between women who will deliver spontaneously and whose who require Cesarean section. Proper decision should be made on the basis of objective and valid evaluation of obstetric setting, which cannot be achieved solely with physical examination. Intrapartum sonography was shown to be far more accurate than digital examination. Moreover, it is not technically demanding, provides high reproducibility and neither increases the rate of ascending infection or causes discomfort to the patient. Current research suggests that if used routinely, intrapartum sonography can increase the safety of labor and reduce cesarean section rate.

Role of intrapartum ultrasound in modern obstetrics – current perspectives and literature review

“…Labour management has changed little over the past decades, and it is still based on transvaginal digital examination which, by definition, is subjective and hence associated with a high rate of error. The learning curve for performing manual obstetrical examination according to conventional textbooks is long (3) . While the assessment of cervical dilation does not usually pose major problems, the exact determination of foetal head position and station in the birth canal may be problematic even for specialists with long obstetric experience.…”

Intrapartum assessment of fetal well-being

“…The use of ultrasound to correctly identify fetal head position and orientation can help select an appropriate and safe technique for assisted delivery. 19 Ultrasound can also assess fetal cardiac activity during these deliveries.…”

Intrapartum Sonography versus Digital Vaginal Examination in the First Stage of Labor for Prediction of the Progress of Labor

“…The potential role of Ultrasonography in the evaluation of labor progress has been reported in many previous studies. Despite, The application of ultrasonography to assess labor progress was reported for the first time in 1990, physical examination for labor progress is still used till now (6) .…”