Sargın Mehmet Akif, Ilter Pınar Bırol, Kayabasoglu Furkan, Malvası Antonio, Dogan Ozan, Eren Ecem, Tekin Arzu Bilge, Yassa Murat
Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, İstanbul, Turkey.
Clinic of Obstetrics and Gynecology, Kartal Acıbadem Hospital, İstanbul, Turkey.
J Matern Fetal Neonatal Med. 2025 Dec;38(1):2493192. doi: 10.1080/14767058.2025.2493192. Epub 2025 Apr 21.
Digital vaginal examination (DVE) is a commonly used method in delivery wards to monitor the progress of labor, but it is considered uncomfortable by pregnant women and can lead to infectious complications, such as chorioamnionitis. At the same time, the performance of intrapartum ultrasonography (IPU) is increasing. IPU has a higher inter-observer and intra-observer agreement than DVE. In this study, we evaluated the agreement between IPU and DVE measurements performed by midwives trained in ultrasonography and a specialist obstetrician. Using these data, we assessed the feasibility of midwives administering IPU in delivery rooms for fetal head station and position and cervical dilation.
This prospective study was conducted on the delivery ward at a tertiary healthcare hospital between 1 March and 1 May 2021. The study included women with low-risk pregnancies with a singleton vertex presentation who were admitted to the delivery ward after 37 weeks of gestation. The two midwives underwent a theoretical and practical training program on patients led by an expert obstetric consultant. Cervical dilation, fetal head station and position were recorded through IPU and DVE measurements conducted by two midwives and one expert obstetrician. Cohen's kappa with squared weights was used to assess the agreement between observers. The discomfort score during the examinations was also obtained from the pregnant women and recorded (0 = no discomfort, 10 = very uncomfortable).
The study included 196 pregnant women. There was mostly moderate or substantial agreement between the midwives and obstetric consultant in the variables of cervical dilation, fetal head level and position determined by DVE. In all IPU measurements, these agreements were perfect among all observers. While the intra-observer agreement of the obstetric consultant in IPU and DVE was perfect, in midwives, it was analyzed as substantial in cervical dilation, fair and moderate in the head station, and moderate and perfect in head position. The mean discomfort scores of the pregnant women due to IPU and DVE were 2.89 ± 1.49 and 5.98 ± 2.02, respectively. The differences in discomfort scores between the two examinations were detected to be statistically significant ( < 0.001).
IPU can be used by midwives in delivery wards to accurately determine the fetal head position and station and cervical dilation without causing discomfort to pregnant women.
数字阴道检查（DVE）是产房常用的监测产程进展的方法，但孕妇认为其令人不适，且可能导致感染并发症，如绒毛膜羊膜炎。同时，产时超声检查（IPU）的应用越来越广泛。与DVE相比，IPU在观察者间和观察者内的一致性更高。在本研究中，我们评估了接受超声检查培训的助产士和产科专家进行的IPU与DVE测量结果之间的一致性。利用这些数据，我们评估了助产士在产房进行IPU以确定胎头位置、胎头高低及宫颈扩张情况的可行性。
本前瞻性研究于2021年3月1日至5月1日在一家三级医疗机构的产房进行。研究纳入妊娠37周后入住产房的单胎头位低风险妊娠妇女。两名助产士参加了由产科专家顾问主导的针对患者的理论和实践培训项目。通过两名助产士和一名产科专家进行的IPU和DVE测量记录宫颈扩张情况、胎头高低及位置。采用加权平方的Cohen's kappa系数评估观察者之间的一致性。还从孕妇处获取并记录检查期间的不适评分（0 = 无不适，10 = 非常不适）。
本研究纳入196名孕妇。助产士与产科顾问在通过DVE确定的宫颈扩张、胎头高低及位置变量方面大多存在中度或高度一致性。在所有IPU测量中，所有观察者之间的这些一致性均为完美。虽然产科顾问在IPU和DVE中的观察者内一致性为完美，但在助产士中，宫颈扩张方面为高度一致，胎头高低方面为一般和中度一致，胎头位置方面为中度和完美一致。孕妇因IPU和DVE产生的平均不适评分为分别为2.89±1.49和5.98±2.02。检测发现两次检查的不适评分差异具有统计学意义（<0.001）。
产房助产士可使用IPU准确确定胎头位置、胎头高低及宫颈扩张情况，且不会给孕妇带来不适。
