P14.11: Sonographic assessment of fetal head position during the first and second stage of labor for the prediction of persistent occiput posterior position and labor dystocia

Abstract

Methods:The analysis was performed for the 90 patients during first period of labor who have been hospitalized in II Gynecology and Obstetrics Clinic of Medical University in Wroclaw. All the patients have been monitored in Labor Room with continuous electronic CTG monitoring with computerized analysis of FHR tracings. Doppler ultrasound examination in fetal umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) has been performed with portable ultrasound system Voluson I. After cutting off the umbilical cord gas analysis from umbilical artery or vein has been made. Results: There is a statistically significant correlation between pH, pCO2, HCO3 and BE parameters of postpartum gas analysis and Doppler flow parameters in UA and cerebral to placental blood flow ratio (CPR-PIMCA/PIUA). The most significant value in differentiation of fetal condition has respectively been proven for the S/D, RI, PI parameter from UA and CPR ratio. ROC analysis has revealed S/D UA sensitivity reaching 64%, RI UA-57%, PI UA-50%, CPR-43%, with specificity 93%. For the MCA Doppler flow parameters and computerized analysis of CTG tracings sensitivity has reached 7%. Only in the group of patients with abnormal outcomes of computerized analysis of CTG tracings confirmed by abnormal intrapartum Doppler ultrasound examination the postpartum state of a neonate was connected with deterioration of parameters of postpartum gas analysis. Conclusions: Umbilical artery parameters S/D, PI, RI and CPR ratio are statistically significant in predicting fetal condition based on postpartum umbilical cord gas analysis and are useful in verification of abnormal parameters of computerized analysis of CTG tracings.

Ultrasound Criteria for Expecting Mode of Delivery after Induction of Labour in Primigravida with Postdates

“…Fetal head position assessed by TAS in this study showed that 68.3% of subjects in vaginal delivery group showed occipito-anterior head positions compared to 32.8% in CS group. Choi et al concluded that perinatal complications occurred more frequently in OP positions group than OA positions and OT positions groups suggesting that the position of the head during the first and second stage of labor could be useful indicators for predicting the persistent OP position and labor dystocia [7].…”

“…Intrapartum Tran abdominal US of the positions of the fetal head recorded during labor could be useful indicator for expecting persistent Occipito Posterior position and labor induction failure [7].…”