Expert ReviewIntrapartum ultrasound in women with prolonged first stage of labor
Section snippets
Background
Labor and delivery are divided into 3 stages: the first stage is from onset of labor to full dilatation of the cervix, the second stage is from full dilatation of the cervix to delivery of the baby, and the third stage is from the delivery of the baby to the delivery of the placenta. There is no uniform definition of the start and duration of these stages.1
The first stage of labor is divided into the latent phase, often referred to as stage 0, and the active phase. During the latent phase,
Ultrasound assessment of fetal position
Examination of the fetal position with ultrasound is feasible. This can be performed by either a transabdominal scan or a transperineal scan. When performing a transabdominal scan, the intracranial structures are used to determine the position of the fetal head. When the fetal head is at a low station, a transperineal scan is preferred. The midline angle is assessed with a transverse transperineal scan in the frontal plane related to the mother. The falx cerebri is seen as an echogenic line
Ultrasound assessment of fetal head station
The fetal head station can be examined by different TPU examinations. The angle of progression (AoP) is a sagittal transperineal scan where the angle between the long axis of the symphysis and a line joining the lower edge of the symphysis to the lower convexity of the fetal skull is measured (Figure 1).30 Head-perineum distance (HPD) is a transverse transperineal scan. The transducer is placed in the fourchette, and the soft tissue is gently compressed until a resistance is met. Furthermore,
Future perspectives
A sonopartogram has been suggested to assess labor progress. By assessing cervical dilatation, fetal head rotation, and fetal head station with ultrasound, assessing labor progress using ultrasound and reducing the number of clinical examinations have been feasible.7 These kinds of tools can help in decision making when prolonged first stage of labor occurs.
Studies have shown that TPU is well accepted by women.47,48 A randomized controlled trial where women were randomized to routine digital
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Cited by (4)
Incremental risk of clinical chorioamnionitis associated with cervical examination
2022, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Several reports have proposed that transperineal or translabial ultrasound is an effective, feasible, and valid alternative to manual cervical examinations.18,19 Furthermore, intrapartum ultrasound performed in the first and second stage of labor may predict labor outcome and mode of delivery more accurately than traditional digital examination.20,21 However, the risk of chorioamnionitis associated with intrapartum ultrasound remains unclear, and more attention to this tool is warranted.
Duration time of labor progression for pregnant women of vaginal birth after cesarean in Hubei, China
2024, Irish Journal of Medical ScienceEpidural analgesia for labor: effects on length of labor and maternal and neonatal outcomes
2023, European Review for Medical and Pharmacological SciencesHow to Reach the Best Ultrasound Performance in the Delivery Room
2022, Revista Brasileira de Ginecologia e Obstetricia
The authors report no conflict of interest.