Document Detail


Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound.
MedLine Citation:
PMID:  19202576     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor. METHODS: Patients with uncomplicated pregnancies at term gestation with fetuses in vertex presentation in the second stage of labor underwent serial translabial sonography and digital examinations. In a sagittal section of the maternal pelvis, the direction of the head was noted and categorized as downward, horizontal or upward. By rotating the transducer in the transverse plane the cerebral midline echo was also visualized and the rotation of the head was noted. Clinical and ultrasound data were compared using Somer's d-test. RESULTS: Sixty patients underwent a total of 168 clinical and sonographic examinations. When on the sonogram the fetal head was directed downward, the station assessed clinically was most frequently <or= + 1 cm from the ischial spines (44/57 (77.2%) cases); when the direction was horizontal, the station was most frequently <or= + 2 cm (53/59 (89.8%) cases); when the fetal head was directed upward, the station was usually >or= + 3 cm (46/52 (88.5%) cases). Failure to visualize the cerebral midline or a rotation >or= 45 degrees were associated with a station of + 2 cm or less in 98/103 (95.1%) examinations. Conversely, a rotation of < 45 degrees was associated with a station of + 3 cm or more in 45/65 (69.2%) examinations. All comparisons between clinical and sonographic findings demonstrated a statistically significant relationship (P < 0.0001). The probability of a station + 3 cm or more was particularly high when an upward direction of the head was seen in combination with a rotation of < 45 degrees (40/42 (95.2%) examinations). The interobserver variability (Cohen's kappa 0.795 and 0.727 for station and rotation, respectively; P < 0.001) and intraobserver variability (0.845 for both station and rotation, P < 0.001) suggested good reproducibility of the method. CONCLUSIONS: Translabial sonography allows a diagnosis of fetal station with an accuracy comparable to that of digital examination and may provide useful information for diagnosing obstructed labor in the second stage as well as assisting in the choice of instrumental delivery.
Authors:
T Ghi; A Farina; A Pedrazzi; N Rizzo; G Pelusi; G Pilu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  33     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-04     Completed Date:  2010-02-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  331-6     Citation Subset:  IM    
Copyright Information:
(c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy. tullioghi@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Gestational Age
Head / embryology,  ultrasonography*
Humans
Labor Presentation
Labor Stage, Second*
Observer Variation
Obstetric Labor Complications / prevention & control,  ultrasonography*
Pregnancy
Ultrasonography, Prenatal / methods*
Vulva
Comments/Corrections
Comment In:
Ultrasound Obstet Gynecol. 2009 Jun;33(6):735; author reply 736   [PMID:  19434619 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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