Impact of ultrasound guided training in the diagnosis of the fetal head position during labor: A prospective observational study

It is time for midwives to perform intrapartum ultrasonography for fetal head station, position and cervical dilation

OBJECTIVE

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.

METHODS

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).

RESULTS

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 (p < 0.001).

CONCLUSION

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.

Impact of additional theoretical training program in the diagnosis of the fetal head position during labor: a prospective observational study

BACKGROUND

The accuracy of transvaginal digital examination in determining foetal head position is not high enough. This study aimed to evaluate whether an additional training on our new theory could improve the diagnostic accuracy of the foetal head position.

METHODS

This was a prospective study conducted at a 3a grade hospital. The study included 2 residents in their first year of training in obstetrics without prior experience in transvaginal digital examination. In the observational study, 600 pregnant women without contraindications to vaginal delivery were included. Two residents were simultaneously trained in the theory of traditional vaginal examination, but resident B received an additional theoretical training program. The pregnant women were randomly assigned to have the foetal head position examined by resident A and resident B. The foetal head position was then confirmed by ultrasound, which was performed by the main investigator. After 300 examinations were independently performed by each resident, the accuracy of foetal head position and perinatal outcomes were compared between the two groups.

RESULTS

During the 3-month period, 300 post training transvaginal digital examinations were performed by each resident in our hospital. The two groups were found to be homogeneous for age at delivery, BMI before delivery, parity, gestational weeks at delivery, the rate of epidural analgesia, foetal head position, presence of caput succedaneum, presence of moulding and foetal head station(p > 0.05). The diagnostic accuracy of head position by digital examination was higher for resident B, who was subjected to an additional theoretical training program, than for resident A (75.00% vs. 60.67%, p < 0.001). There were no significant differences in maternal and neonatal outcomes between the two groups (p > 0.05).

CONCLUSION

An additional theoretical training program for residents increased the accuracy of vaginal assessment of foetal head position.

TRIAL REGISTRATION

Registered at Chinese Clinical Trial Registry Platform (ChiCTR2200064783), October 17, 2022. https://www.chictr.org.cn/edit.aspx?pid=182857&htm=4.