The Feasibility About Ultrasonography Replaces Traditional Vaginal Examination In Labor Monitoring

Progression of labor has traditionally been evaluated by vaginal examination.The vaginal examination assesses cervical dilatation,fetal presentation,fetal position and descent.The vaginal examination remains the 'gold standard' for evaluating all three parameters in labor.However,vaginal examination has been demonstrated to be subjective and often inaccurate.Furthermore,repeated examinations are uncomfortable and potentially associated with an increased risk of intrauterine infections once membranes are ruptured.Besides that,the vaginal examination may lead to high unnecessary cesarean section rates.Reducing the number of vaginal examinations during labor may limit these risks and increase patient comfort.Recently,more and more obstetricians have realized that the traditional method to evaluate labor parameters is subjective and inaccurate,and it lead to labor progress lack of standardized management,which has been the bottleneck during the labor progress.More and more medical workers have studied to use ultrasonography in the labor monitoring since the ultrasonography was used to check Pelvic floor in 2005.Especially in recently years,along with portablebedside ultrasound extensive use and obstetricians/midwifes ultrasonic technique improved,the obstetricians both at home and abroad have tried to use ultrasonography during the labor monitoring.Objective:To discuss the clinical significance of abdomen operineal ultrasonography(2D)to test cervical dilatation,fetal position and fetal decent.And the study is to discuss whether the ultrasonography can replace traditional vaginal examination during the labor monitoring.Methods:One hundred pregnant women who preferred to vaginal delivery in our hospital were included in this study from Nov.2015 to Oct.2016.Ninety-three of them had vaginal deliveries(89 were spontaneous vaginal delivery and 4 were operative vaginal delivery)and7 had cesarean sections.This was a prospective observational study of women with singleton.The study was approved by abdominal joint the perineum ultrasound(2D-US).Fetal position was measured by abdominal ultrasound methods.The trans-perineal ultrasound methods measuring fetal head descent based on the angle of progression in the images obtained.The trans-perineal ultrasound methods measuring cervical dilatationbased on cervical lip distance.The ultrasound method was operated by two obstetricians with more than 10 years' clinical experience and 3 years' ultrasound experience,and the traditional vaginal examination was handled by midwifes with>5 years' clinical experienceThe relationship between the cervical lip distance from ultrasonography and the cervical dilatation from vaginal examination was analyzed with linear regression.The relationship between the progression angle and the fetal head station from vaginal examination was analyzed with linear regression.Results:2Dultrasonography fetal position has 100%correct rate,while the traditional vaginal examination was only 74.76%.The mean distance of cervical lip tested by ultrasonography was(5.70±2.55)cm,the mean cervical dilatation tested by vaginal examination was(5.88±2.56)cm,the mean error was(0.15 ±0.36)cm(95%confidence interval(CI)0.09?0.21),and the sum of absolute error(MAE)was(0.31±0.23)cm(95%CI 0.27?0.35)?There was a significant linear correlation between the cervical lip distance from ultrasonography and the cervical dilatation from vaginal examination,The linear regression equations was:Y vaginal examination=1.0315×ultrasonography-0.0311(R2=0.9813,P<0.05).There was a significant linear correlation between the progression angle or progression distance and the fetal head station from digital examination.The linear regression equations were:Y(angle of progression)= 10.678X + 100.78(R2=0.8898,P<0.05).Conclusion:The study indicates that the 2D ultrasonography can replace traditional vaginal examination during the labor monitoring.Because the ultrasonography method is no-trauma less painful,low risk,objective and economy,and then the 2D ultrasonography should be widely used during labor monitoring.