Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain.
Ultrasound Obstet Gynecol. 2024 Aug;64(2):214-221. doi: 10.1002/uog.27634. Epub 2024 Jul 5.
Well-established clinical practice for assessing progress in labor involves routine abdominal palpation and vaginal examination (VE). However, VE is subjective, poorly reproducible and painful for most women. In this study, our aim was to evaluate the feasibility of systematically integrating transabdominal and transperineal ultrasound assessment of fetal position, parasagittal angle of progression (psAOP), head-perineum distance (HPD) and sonographic cervical dilatation (SCD) to monitor the progress of labor in women undergoing induction of labor (IOL). We also aimed to determine if ultrasound can reduce women's pain during such examinations.
Women were recruited as they presented for IOL in three maternity units. Ultrasound assessments were performed in 100 women between 37 + 0 and 41 + 6 weeks' gestation. A baseline combined transabdominal and transperineal scan was performed, including assessment of fetal biometry, umbilical artery and fetal middle cerebral artery Doppler, amniotic fluid index, fetal spine and occiput positions, psAOP, HPD, SCD and cervical length. Intrapartum scans were performed instead of VE, unless there was a clinical indication to perform a VE, according to protocol. Participants were asked to indicate their level of pain by verbally giving a pain score between 0 and 10 (with 0 representing no pain) during assessment. Repeated measures data were analyzed using mixed-effect models to identify significant factors that affected the relationship between psAOP, HPD, SCD and mode of delivery.
A total of 100 women were included in the study. Of these, 20% delivered by Cesarean section, 65% vaginally and 15% by instrumental delivery. There were no adverse fetal or maternal outcomes. A total of 223 intrapartum ultrasound scans were performed in 87 participants (13 women delivered before intrapartum ultrasound was performed), with a median of two scans per participant (interquartile range (IQR), 1-3). Of these, 76 women underwent a total of 151 VEs with a median of one VE per participant (IQR, 0-2), with no significant difference between vaginal- or Cesarean-delivery groups. After excluding those with epidural anesthesia during examination, the median pain score for intrapartum scans was 0 (IQR, 0-1) and for VE it was 3 (IQR, 0-6). Cesarean delivery was significantly associated with a slower rate of change in psAOP, HPD and SCD.
Comprehensive transabdominal and transperineal ultrasound assessment can be used to assess progress in labor and can reduce the level of pain experienced during examination. Ultrasound assessment may be able to replace some transabdominal and vaginal examinations during labor. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估胎儿位置、矢状角进展（psAOP）、头会阴距离（HPD）和超声宫颈扩张（SCD）的经腹和经会阴超声评估系统整合在评估引产（IOL）中分娩进展的可行性。我们还旨在确定超声是否可以减轻女性在这些检查中的疼痛。
本研究纳入了三家产科单位中接受 IOL 的女性。在 37+0 至 41+6 周妊娠的 100 名女性中进行了超声评估。进行了基线联合经腹和经会阴扫描，包括评估胎儿生物测量、脐带动脉和胎儿大脑中动脉多普勒、羊水指数、胎儿脊柱和枕骨位置、psAOP、HPD、SCD 和宫颈长度。根据方案，如果有临床指征需要进行 VE，则进行产时扫描代替 VE。参与者在评估过程中通过口头给出 0 到 10 之间的疼痛评分来表示他们的疼痛程度（0 表示无痛）。使用混合效应模型分析重复测量数据，以确定影响 psAOP、HPD、SCD 和分娩方式之间关系的显著因素。
本研究共纳入 100 名女性。其中，20%经剖宫产分娩，65%经阴道分娩，15%经器械分娩。没有不良的胎儿或产妇结局。在 87 名参与者中进行了总共 223 次产时超声检查（13 名女性在进行产时超声检查前分娩），每名参与者的中位数为两次扫描（四分位距（IQR），1-3）。其中，76 名女性共进行了 151 次 VE，每名参与者的中位数为一次 VE（IQR，0-2），阴道分娩组和剖宫产组之间无显著差异。排除检查期间接受硬膜外麻醉的患者后，产时扫描的中位数疼痛评分为 0（IQR，0-1），VE 为 3（IQR，0-6）。剖宫产与 psAOP、HPD 和 SCD 变化率较慢显著相关。
全面的经腹和经会阴超声评估可用于评估分娩进展，并可减轻检查过程中的疼痛程度。超声评估可能能够替代分娩期间的一些经腹和阴道检查。© 2024 作者。《超声妇产科杂志》由 John Wiley & Sons Ltd 出版，代表国际妇产科超声学会。
