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. 2018 Jun 6:10:251-256.
doi: 10.2147/IJWH.S155865. eCollection 2018.

Intrapartum ultrasound: viewpoint of midwives and parturient women and reproducibility

Adrielle Van Adrichem  1 , Ellen Faes  1 , Kristof Kinget  2 , Yves Jacquemyn  1
Affiliations

Intrapartum ultrasound: viewpoint of midwives and parturient women and reproducibility

Adrielle Van Adrichem et al. Int J Womens Health. .

Abstract

Introduction: Vaginal examination (VE) is known to be subjective in interpretation and is considered uncomfortable by many women. Intrapartum ultrasound aims to be more objective and less invasive. The purpose of this study was to evaluate the acceptability of introducing intrapartum ultrasound to both midwives and parturients. Furthermore, we wanted to evaluate the reproducibility of different measurements when introduced de novo among operators without prior ultrasound experience.

Subjects and methods: This study determined intra- and interobserver variability of intrapartum ultrasound in nulliparous women in labor. Ultrasound examinations were performed independently by a midwife and a gynecologist. The symphysis-head distance (SHD) and the angle of progression (AOP) were measured by translabial ultrasound. Structured questionnaires were given to midwives and parturients. Intraclass correlation coefficient (ICC) and limits of agreement (LA) were calculated to evaluate variability.

Results: A total of 33 patients were included; of whom, 28 filled in the questionnaire. A total of 19 midwives working on a delivery ward were asked to respond to the questionnaire, and 13 returned the forms. Midwives clearly continued to prefer VE over ultrasound, the majority evaluated translabial ultrasound as easy to use, but some declared to be unable to use it. The majority of patients, 71%, preferred ultrasound over VE. Reproducibility of intrapartum trans-labial ultrasound was good; ICC for interobserver variability was 0.603 (p=0.001) for SHD, and ICC for intraobserver variability was 0.844 (p<0.001) and 0.914 (p<0.001) for SHD and AOP, respectively.

Conclusion: Patients prefer ultrasound over VE; midwives tend to stick to trusted VE. Reproducibility of intrapartum ultrasound in non-experienced operators is good.

Keywords: intrapartum; labor; ultrasound.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
SHD is measured by drawing a line through the symphysis (A) and from the end of the symphysis a second line perpendicular to the fetal skull (B); the last line is the SHD. Abbreviation: SHD, symphysis–head distance.
Figure 2
Figure 2
AOP is measured by drawing a line through the axis of the symphysis to the lowest point of the symphysis (A); next, from this point, a line is drawn at the anterior border of the skull (C); the angle between these two lines is measured (B) and it is the AOP. Abbreviation: AOP, angle of progression.
Figure 3
Figure 3
Bland–Altman plot for interobserver variability between two observers for SHD. Note: Red line represents mean; green lines represent ±1.96 SD. Abbreviation: SHD, symphysis–head distance.
Figure 4
Figure 4
Bland–Altman plot for interobserver variability for AOP. Note: Red line represents mean; green lines represent ±1.96 SD. Abbreviation: AOP, angle of progression.
See this image and copyright information in PMC

References

    1. Benediktsdottir S, Eggebo TM, Salvesen KA. Agreement between transperineal ultrasound measurements and digital examinations of cervical dilatation during labor. BMC Pregnancy Childbirth. 2015;15:273. - PMC - PubMed
    1. Hassan WA, Eggebo TM, Ferguson M, Lees C. Simple two-dimensional ultrasound technique to assess intrapartum cervical dilatation: a pilot study. Ultrasound Obstet Gynecol. 2013;41(4):413–418. - PubMed
    1. Debska M, Kretowicz P, Debski R. Intrapartum sonography – eccentricity or necessity? J Ultrason. 2015;15(61):125–136. - PMC - PubMed
    1. Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol. 2003;21(5):437–440. - PubMed
    1. Malvasi A, Giacci F, Gustapane S, Sparic R, Barbera A, Tinelli A. Intrapartum sonographic signs: new diagnostic tools in malposition and malrotation. J Matern Fetal Neonatal Med. 2016;29(15):2408–2413. - PubMed

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