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

Abstract

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.

Reliability of ultrasound versus digital vaginal examination in detecting cervical dilatation during labor: a diagnostic test accuracy systematic review

“…The characteristics of the included studies are shown in Table 1. Three of the studies were conducted in the UK [11,12,24], and seven in each of following countries: Spain [25], South Korea [7], Republic of Ghana [3], Tunisia [26], Sweden [27], Turkey [28], and Israel [15]. All studies were performed in the hospital setting.…”

“…Vaginal digital examinations were performed before or immediately after the ultrasound examination by the responsible birth attendant. Six studies recruited both nulliparous and multigravida women [3,7,15,24,25,28], and one study enrolled only nulliparous women [11]. One study used TLUS (trans-labial ultrasound) method, and other studies adopted TPUS (trans-perineal ultrasound) method.…”

Ultrasound in labor: clinical practice guideline recommendation by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)

“…This examination method can be painful, [6,7] associated with ascending infection [8] to the fetus and mother, and largely subjective. [9,10] Intrapartum ultrasound is better tolerated [11,12] by women than the traditional method of vaginal examinations and its use has been increasingly researched as an adjunct tool in labor for determination of cervical dilatation, fetal head position and station whilst maintaining sterility. Obstetricians can become competent in basic ultrasound techniques in order to recognize acute clinical emergencies as well as improve the recognition of labor arrest.…”

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

“…Supplementing medical records with objective intrapartum ultrasound findings in the form of scan may help prove the validity of actions taken during labour (42) . It is hoped, though there is no evidence yet, that the use of intrapartum ultrasound will reduce the frequency of performing transvaginal digital examinations (34) , and hence contribute to lowering the risk of intrauterine infections.…”

“…One study, performed on a small group of patients (57), showed that in the vast majority of cases (96.5%), a decision to admit pregnant women at term to hospital due to labour was possible based solely on the TPU findings which were consistent with the results of manual gynaecological examination. The authors ventured the conclusion that TPU performed before admitting a patient makes it possible to avoid up to 90% of transvaginal digital examinations (34) . The method could be particularly useful in cases of false labour, when the patient frequently undergoes a number of unnecessary transvaginal digital examinations.…”