Abstract

Intra Partum Transperineal Ultrasound to Assess the Progress of Labour and to Predict the Mode of Delivery-A Hospital Based Study

Background: In our country, the rate of emergency cesarean section is increasing year after year by quoting the fetal head station and failure of progress during labor as the major reason for cesarean surgery. The digital vaginal examination is more subjective, the more objective type of assessing the progression of labor by using transperineal ultrasound was recently being used by most of the obstetrician. Aim: To assess the validity of measuring fetal head station, and decent during labor using transperineal ultrasound in assessing the progress of labor. Methodology: A prospective longitudinal study was conducted for one year. A total of 200 study subjects were included as our study subjects with inclusion criteria being singleton with at least 37 weeks of pregnancy and with the longitudinal cephalic type of presentation. Using GE ultrasound machine transperineal ultrasound was performed and the angle of progression was measured by two different obstetricians and the average for two was taken as the final reading. Results: Using the transperineal ultrasound the angle of progression was measured in the first stage of labor for all the antenatal mothers and it was found that the mean angle of progression among the mothers delivered through normal vaginal delivery was 116° and for the cesarean section it was 89° and a statistically significant difference was observed between the two groups. A receiver operator curve was plotted between the angle of progression and normal vaginal delivery and it was shown that antenatal mothers with AOP greater than 99.6° are more prone to deliver by normal vaginal delivery. Conclusion: The angle of progression is the most reproducible ultrasound parameter for the assessment of fetal head descent during labor and it is directly proportional to the probability of vaginal delivery.

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