Role Of Transperineal Ultrasound In Assessment Of Fetal Head Engagement As Indication Of Caesarean Section Taking Mode Of Delivery As Gold Standard

Abstract

The frequency of caesarean sections has been gradually increasing in the past several decades. The usage of transperineal ultrasound (TPU) has been increasing. Many studies have demonstrated that TPU can provide valuable information for the clinician. Objective: To assess the role of transperineal ultrasound in fetal head engagement as indication of caesarean section taking mode of delivery as gold standard. Methods: A cross-sectional study was carried out in Radiology Department of Nawaz Medicare and DHQ hospital, Faisalabad. Written consent was taken from all patients before the ultrasound examination. Patients were assessed for eligibility in inclusion criteria. Confirmation of intrauterine living pregnancy, placenta site, fetal presentation, liquor amount and gestational age was done with routine obstetric ultrasound. Enrolled pregnant patients at term were assessed for the fetal head-perineal distance and cervical length by TPU examination. Results: One hundred and twenty-four (124) women participated in the investigation. Maternal age and gestational age were not determinants of outcomes of labor. Fetal head-perineal distance measured by TPU had a test sensitivity of 88.31 %, specificity of 78.72 %, the positive predictive value is 87.18%, the negative predictive value is 80.43% and diagnostic accuracy is 84.68%. Conclusions: The findings of this study shows that head perineal distance measured by TPU have higher sensitivity and is a non-invasive method which provides valuable objective measurements for fetal head engagement in primigravida at term and can be easily accepted and tolerated by women. Also, unnecessary caesarean section rate can be reduced by timely decision.