Prediction of the Mode of Delivery using Intrapartum Translabial Ultrasound in a Teaching Hospital in South India – A prospective observational study
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Abstract
Objectives: Cervical effacement and dilatation, station of the presenting part, and fetal head position are the key determinants of progress of labor. There is growing evidence about the usefulness of intrapartum ultrasound in evaluating the labor parameters objectively to decide about the labor management. Hence, intrapartum translabial ultrasound was studied to predict the mode of delivery.
Materials and Methods: 185 laboring women with singleton pregnancy, term gestation, and cephalic presentation with 4 cm. cervical dilatation were included. Intrapartum translabial ultrasound was done to note angle of progression (AoP), cervical length, and position of the fetal head.
Results: Among 185 women, 121 (65.4%) had vaginal (112 normal and 9 assisted vaginal) and 64 cesarean (34.6%) delivery. An angle of progression of 89o with area under the curve (AUC) 0.789 (p ≤ 0.0001) measured in the early active phase of labor had a sensitivity, specificity, positive predictive value and negative predictive value of 79.3% and 65.6%, 81.3% and 62.7% respectively. The positive likelihood ratio and the negative likelihood ratio were 2.3 and 0.315, respectively. The clinical utility index for AoP was 0.644 in predicting the mode of delivery. AUC for cervical length was 0.534 (p = 0.452), which was not significant. The odds ratio for occipitoanterior position in predicting vaginal delivery was 3.9.
Conclusion: Intrapartum translabial ultrasound is a reproducible and feasible method to evaluate labor parameters. Assessing multiple components like the angle of progression, cervical length, and position of the fetal head in early labor could help to predict the mode of delivery.
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