Ultrasound in labor: a caregiver's perspective

Abstract

In the last decade, the use of ultrasound in labor has been the subject of much research. Suggested applications include confirmation of fetal viability, identification of fetal presentation and assessment of fetal occiput position and head descent. Nevertheless, it is not clear whether this has changed the practice of caregivers outside the research context; and if it has, it is not clear how. In order to assess this, we performed a survey in April 2012 among participants on courses on prenatal medicine and obstetric ultrasound at the Department of Obstetrics and Gynecology of the Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Participants whose duties included management of labor were invited to answer an online questionnaire. In total, 264 attending physicians completed the questionnaire. The most relevant results are displayed in Table 1. According to our survey, the most popular application of ultrasound in labor was for assessment of fetal occiput position (Table 1). This finding is not surprising given that transabdominal sonographic identification of fetal occiput position is easy to achieve through visualization of anatomical landmarks, such as fetal orbits and the spine, as well as requiring minimal time123. Furthermore, a number of studies have demonstrated the superiority of ultrasound over digital examination for this aim, and are consistent and unequivocal in their support of its use as the gold standard for this clinically important variable123. Sonographic assessment of fetal head position can offer extremely valuable information in certain clinical situations, for instance before instrumental delivery, whereas it seems to be a poor predictor of mode of delivery3, 4. On the other hand, ultrasound was less widely used among survey participants for the assessment of fetal head station and progression (Table 1). We suggest three main obstacles to the application of sonography for this purpose. The first is accessibility to ultrasound equipment; less than half of the participants had an ultrasound machine permanently stationed in their delivery suite. The second obstacle is the absence of convincing data on the utility of ultrasound for this purpose. Lastly, the complexity of the sonographic parameters suggested so far may partially impede the implementation of ultrasound for evaluation of the progression of labor in clinical practice. We acknowledge that more detailed questions about each intrapartum ultrasound parameter would have been useful, however the main goal of this survey was not a comparison between individual parameters. We do also recognize a potential bias in our data. As the chief subject of our courses is ultrasound in obstetrics, the participants who answered the questionnaire are likely to be more experienced in ultrasound than other personnel working in the labor ward. Our survey provides original data on the current use of ultrasonography in the labor ward from the key perspective of the caregiver. It suggests that the publication of more convincing, clinically applicable data and the development of less complex sonographic methods, as encouraged in a recent Opinion article in this Journal3, would promote wider use of intrapartum sonography, especially for the assessment of fetal head descent. A. Youssef*†, T. Ghi†, E. E. Awad‡, E. Maroni†, E. Montaguti†, N. Rizzo† and G. Pilu† †Department of Obstetrics and Gynecology, Sant'Orsola Malpighi Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy; ‡Department of Obstetrics and Gynecology, El-Shatby Hospital, University of Alexandria, Egypt *Correspondence. (e-mail: [email protected])