DIGITAL VAGINAL EXAMINATION VS TRANSABDOMINAL ULTRASOUND ASSESSMENT TO DIAGNOSE MALPOSITION BEFORE ATTEMPTING INSTRUMENTAL VAGINAL DELIVERY – WHICH IS A BETTER TOOL
DOI:
https://doi.org/10.55519/JAMC-01-13954Abstract
Background: Fetal malposition play a vital role in the progress of labor and correct identification of the fetal position may impact the mode of delivery. The main purpose of this comparative cross-sectional study is to diagnose fetal malposition on vaginal versus ultrasound examination before attempting instrumental vaginal delivery at a tertiary care hospital setting in Pakistan. Place and Duration: Gynaecology and Obstetrics department Tertiary care hospital, Pakistan. August 2023 - January 2024. Methods: Pregnant females with singleton pregnancy of any age group without any previous history of systemic disease, booked cases with an indication of operative vaginal delivery were included in the study. Using non-probability consecutive sampling technique Group-V (n=72) patients underwent a digital vaginal exam however Group-U (n=72) underwent ultrasound trans-abdomen during the second stage of labor. The position of the fetus on a digital vaginal exam (DVE), and transabdominal ultrasound was recorded. Visual identification of the occiput position was recorded and considered the gold standard. Results: Median (IQR) age in years was 30.5(28-32). The recorded BMI of the participants was 28(26-30) Kg/m2 and most of these pregnant patients had parity 2. The median time taken to perform the exam in seconds was 16(15-18.5) in Group-V as compared to 35 (32–38) in Group-U (p-value<0.001). Occiput anterior including (OA, LOA, and ROA) were the most common fetal positions observed in both groups. The DVE was able to correctly identify the fetal position in 54(75%) patients as compared to 67(93.1%) correct findings after the ultrasound exam with a p-value of 0.003. Conclusion: Transabdominal ultrasound is a more reliable modality as compared to digital vaginal examination in identifying fetal malposition before instrumental vaginal delivery.
References
1. Wegner EK, Bernstein IM. Operative vaginal delivery. Up-ToDate, Post, TW (Ed), UpToDate, Waltham, MA. 2020.
2. Barrowclough J, Kool B, Crowther C. Fetal malposition in labour and health outcomes for women and their newborn in-fants: A retrospective cohort study. PLoS One 2022;17(10):e0276406.
3. Mappa I, Tartaglia S, Maqina P, Makatsariya A, Ghi T, Rizzo G, et al. Ultrasound vs routine care before instrumental vagi-nal delivery: a systematic review and meta‐analysis. Acta Obstet Gynecol Scand 2021;100(11):1941–8.
4. Zegarra RR, di Pasquo E, Dall’Asta A, Minopoli M, Armano G, Fieni S, et al. Impact of ultrasound guided training in the diagnosis of the fetal head position during labor: A prospec-tive observational study. Eur J Obstet Gynecol Reprod Biol 2021;256:308–13.
5. Siergiej M, Sudoł-Szopińska I, Zwoliński J, Śladowska-Zwolińska AM. Role of intrapartum ultrasound in modern obstetrics–current perspectives and literature review. J. Ultra-son 2019;19(79):295–301.
6. Mappa I, Tartaglia S, Maqina P, Makatsariya A, Ghi T, Rizzo G, et al. Ultrasound vs routine care before instrumental vagi-nal delivery: a systematic review and meta‐analysis. Acta Obstet Gynecol Scand 2021;100(11):1941–8.
7. Calandra D, Mercaldi M, De Vito M, Buca D, Liberati M, Lucidi A, et al. Comparison between trans-vaginal and trans-abdominal ultrasound examination of the cervix in the sec-ond trimester of pregnancy: a prospective study. J Perinat Med 2024;52(1):76–80.
8. Barros JG, Afonso M, Martins AT, Carita AI, Clode N, Ayres‐de‐Campos D, et al. Transabdominal and transperineal ultra-sound vs routine care before instrumental vaginal delivery–A randomized controlled trial. Acta Obstet Gynecol Scand 2021;100(6):1075–81.
9. Chou MR, Kreiser D, Taslimi MM, Druzin ML, El-Sayed YY. Vaginal versus ultrasound examination of fetal occiput posi-tion during the second stage of labor. Am J Obstet Gynecol 2004;191(2):521–4.
10. Usman S, Wilkinson M, Barton H, Lees CC. The feasibility and accuracy of ultrasound assessment in the labor room. J Matern Fetal Neonatal Med 2019;32(20):3442–51.
11. Teimoori B, Ashkzari AK, Farzaneh F. Comparative Study of Ultrasound with Transvaginal Finger Examination in Diag-nosis of Abnormal Position and Presentation of Fetal Head. Zahedan J Res Med Sci 2021;23(4):106566.
12. Wang JG, Sun JL, Shen J. Factors affecting failed trial of labor and countermeasures: A retrospective analysis. World J Clin Cases 2020;8(16):3483.
13. Nouri-Khasheh-Heiran E, Montazeri A, Conversano F, Kashanian M, Rasuli M, Rahimi M, et al. The success of vag-inal birth by use of trans-labial ultrasound plus vaginal ex-amination and vaginal examination only in pregnant women with labor induction: a comparative study. BMC Pregnancy Childbirth 2023;23(1):3.
14. Moonsri R, Panburana P, Bumrungphuet S. The Comparison of Intrapartum Sonographic Signs and Digital Examination in Fetus with Cephalic Presentation. J Med Assoc Thai 2020;103(11):10949.
15. Zahalka N, Sadan O, Malinger G, Liberati M, Boaz M, Glezerman M, et al. Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in the second stage of labor. Am J Obstet Gynecol 2005;193(2):381–6.
16. Wiafe YA, Whitehead B, Venables H, Dassah ET. Comparing intrapartum ultrasound and clinical examination in the as-sessment of fetal head position in African women. J. Ultrason 2019;19(79):249–54.
17. Bellussi F, Di Mascio D, Salsi G, Ghi T, Dall’Asta A, Zullo F, et al. Sonographic knowledge of occiput position to de-crease failed operative vaginal delivery: a systematic review and meta- analysis of randomized controlled trials. Am J Ob-stet Gynecol 2022;226(4):499–509.
18. Eggebø TM. Ultrasound Is an Important Diagnostic Tool in Active Labor. Matern Fetal Med 2019;1(1):7–9.
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