The Routine Use of Intrapartum Ultrasound in Clinical Decision-Making during the Second Stage of Labor - Does It Have Any Impact on Delivery Outcomes?

Abstract

Background/aims: The study aimed to assess whether the use of intrapartum transperineal ultrasound (US) can reduce the rate of failed vacuum extraction (VE).

Methods: This is a retrospective cohort study including all women delivering at term with the diagnosis of protracted second stage of labor. The mode of delivery and rate of failed VE were compared between women who underwent a US examination prior to the decision on obstetrical interventions ("+US" group) and those in whom clinical decisions were based upon digital assessment only ("no-US" group).

Results: The study included 635 women. Among the "no-US" group (536), there were 13 failed VE attempts (3.6%) vs. none in the "+US" group (99, p = 0.1). There was a significant difference between the groups regarding mode of delivery (p = 0.001), with a lower cesarean section (CS) rate (20.2 vs. 27.8%) among the "+US" group. Maternal age, body mass index, nulliparity, gestational age at delivery, and birth weight, as well as neonatal short-term outcome did not differ significantly between the 2 groups.

Conclusions: We demonstrate that among women who had the addition of intrapartum US during the second stage of labor there was a trend toward a lower rate of failed VE (although not reaching statistical significance), with a lower rate of CS but not affecting neonatal outcome.

Keywords: Cephalopelvic disproportion; Failed vacuum extraction; Fetal head station/position; Instrumental delivery; Prolonged second stage; Transperineal ultrasound.