Use of intrapartum ultrasound in term pregnant women with contractions before hospital admission

Abstract

Introduction: The aim of this study was to test the hypothesis that transperineal ultrasound can be used to decide whether to admit a pregnant woman due to labor. Material and methods: In this analytical cross-sectional observational study, transperineal ultrasound was performed on pregnant women with intact membranes who came to the hospital due to contractions. A decision was made to admit women due to labor based on the ultrasound measurements. The ultrasound measurements were used to determine cervical dilation, the angle of progression, and fetal head position. The managing midwives were blinded to the results and made the final decision to admit the women based on digital vaginal examination. Results: It was possible to decide whether a woman had to be admitted for delivery or discharged due to the latent phase of labor according to the ultrasound examination in 55 of the 57 cases (96.5%). In four of the 55 cases, the decision based on ultrasound differed from the midwife's decision (7.3%). There was strong agreement between the decision to admit the pregnant women based on ultrasound measurements and the digital vaginal examination (Cohen's kappa: 0.844). It was possible to measure cervical dilation with ultrasound in 52 of the 57 cases (91.2%). The intraclass correlation coefficient for the cervical dilation measurements was 0.736 (95% confidence interval 0.539-0.848). Conclusions: There was strong agreement between the ultrasound and digital vaginal examination results in the decision to admit singleton pregnant women at term due to labor. A large number of vaginal examinations could be avoided by using intrapartum ultrasound.