Intrapartum ultrasonographic assesment in labor management

OBJECTIVE: The aim of our study was to evaluate the caesarean section due to CPD and to evaluate with a ultrasonographic parameter which could be a predictive factor for early diagnosis. We evaluated the ultrasonographic accuracy of the position of the head we determined by vaginal examination and we aimed to compare the effect of the measurements on the time of delivery. MATERIAL AND METHODS: The study was designed as a prospective study. In the study, the cases were selected from the pregnant women who applied to the maternity ward between April 2018 and April 2019 in Uludag University Medical Faculty Obstetrics and Gynecology Department. The study group consisted of 49 nullipara and 29 multiparous women. Patients had cervical dilatation of 3 centimeters at the beginning of labor and 6 centimeters of cervical dilatation during the progress of the action. The head-symphysis distance, head position, fetal facial structures, asinclitsm and caput succedenaum were evaluated by ultrasonography. After the data were collected, a statistical analysis was performed to investigate the relationship between ultrasound findings, duration of action and necessity of operative delivery. Statistical studies were performed with SPSS 21.0. RESULTS: We evaluated the head-symphysis distance and fetal head access to pelvis. BSM 22.2 mm in the presence of 3 cm cervical dilatation; In the presence of 6 cm cervical dilatation, the risk of CPD-induced cesarean section was higher in patients with BSM above 12.2 mm (p: 0.039, p: 0.012). When we compared the accuracy of vaginal examination, the head position, which was determined by vaginal examination and ultrasonography in pregnant women who had head-symphysis distance above 22.2 mm in 3 cm cervical dilatation, showed statistically significant difference (p: 0.001). The ultrasonographic presentation of the structures of the fetal face did not correlate with the mode of delivery (p: 0.86). While the vaginal delivery was frequently performed in the group that performed the rotation correctly, the cesarean section rates due to CPD increased in the group that did not rotate (p: 0.001). The risk of caesarean section was found to be increased in patients who underwent ultrasonography by the presence of asincliticism and caput succedenaum (p: 0.001, p: 0.001). CONCLUSION: When we evaluate the patients with the presence of head-symphysis distance, rotation, caput succedaneum and asinklitism, we can estimate CPD-induced cesarean section by 70.8% according to the logistic regression analysis. The ultrasonographic presence of the parameters that we foresee to be a risk factor is useful in supporting the diagnosis in patients with an arrest of the action.