Inaccuracy in cervical dilatation assessment and the progress of labour monitoring

Letić, Milorad

doi:10.1016/s0306-9877(02)00358-4

Cited by 21 publications

(14 citation statements)

References 16 publications

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“…The nature of VE as a manual procedure depends on the providers’ perception, gave the base to be criticized for limited accuracy [22,23] and considered an imprecise measurement if conducted by different providers [24]. The relationship between VEs during labor and infections was documented [25].…”

Section: Introductionmentioning

confidence: 99%

The paradox of vaginal examination practice during normal childbirth: Palestinian women’s feelings, opinions, knowledge and experiences

et al. 2012

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BackgroundVaginal examination (VE), is a frequent procedure during childbirth. It is the most accepted ways to assess progress during childbirth, but its repetition at short intervals has no value. Over years, VE continued to be plagued by a nature that implies negative feelings and experiences of women. The aim of this exploratory qualitative study was to explore women’s feelings, opinions, knowledge and experiences of vaginal examinations (VE) during normal childbirth.MethodsWe interviewed 176 postpartum women using semi-structured questionnaire in a Palestinian public hospital in the oPt. Descriptive statistics were conducted; frequency counts and percentages for the quantitative questions. The association between the frequency of VE and age, parity, years of education, locale and the time of delivery was tested by Chi-squared and Fisher’s Exact test. The open-ended qualitative questions were read line-by-line for the content and coded. The assigned codes for all responses were entered to the SPSS statistical software version 18.ResultsAs compared with WHO recommendations, VE was conducted too frequently, and by too many providers during childbirth. The proportion of women who received a ‘too high’ frequency of VEs during childbirth was significantly larger in primipara as compared to multipara women (P = .037). 82% of women reported pain or severe pain and 68% reported discomfort during VE. Some women reported insensitive approaches of providers, insufficient means of privacy and no respect of dignity or humanity during the exam.ConclusionsPalestinian women are undergoing unnecessary and frequent VEs during childbirth, conducted by several different providers and suffer pain and discomfort un-necessarily.Practice implicationsAdhering to best evidence, VE during childbirth should be conducted only when necessary, and if possible, by the same provider. This will decrease the laboring women’s unnecessary suffering from pain and discomfort. Providers should advocate for women’s right to information, respect, dignity and privacy.

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Section: Introductionmentioning

confidence: 99%

The paradox of vaginal examination practice during normal childbirth: Palestinian women’s feelings, opinions, knowledge and experiences

et al. 2012

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“…individuals did not always over or underestimate the measurement. This is of concern as the decisions made regarding progress and interventions in labour often rely on measurement of cervical dilatation [7]. Such interventions include artificial rupture of membranes, use of oxytocin and even caesarean section.…”

Section: Introductionmentioning

confidence: 99%

The purple line as a measure of labourprogress: a longitudinal study

Shepherd

Cheyne

Kennedy

et al. 2010

BMC Pregnancy Childbirth

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BackgroundVaginal examination (VE) and assessment of the cervix is currently considered to be the gold standard for assessment of labour progress. It is however inherently imprecise with studies indicating an overall accuracy for determining the diameter of the cervix at between 48-56%. Furthermore, VEs can be unpleasant, intrusive and embarrassing for women, and are associated with the risk of introducing infection. In light of increasing concern world wide about the use of routine interventions in labour it may be time to consider alternative, less intrusive means of assessing progress in labour. The presence of a purple line during labour, seen to rise from the anal margin and extend between the buttocks as labour progresses has been reported. The study described in this paper aimed to assess in what percentage of women in labour a purple line was present, clear and measurable and to determine if any relationship existed between the length of the purple line and cervical dilatation and/or station of the fetal head.MethodsThis longitudinal study observed 144 women either in spontaneous labour (n = 112) or for induction of labour (n = 32) from admission through to final VE. Women were examined in the lateral position and midwives recorded the presence or absence of the line throughout labour immediately before each VE. Where present, the length of the line was measured using a disposable tape measure. Within subjects correlation, chi-squared test for independence, and independent samples t-test were used to analyse the data.ResultsThe purple line was seen at some point in labour for 109 women (76%). There was a medium positive correlation between length of the purple line and cervical dilatation (r = +0.36, n = 66, P = 0.0001) and station of the fetal head (r = +0.42, n = 56, P < 0.0001).ConclusionsThe purple line does exist and there is a medium positive correlation between its length and both cervical dilatation and station of the fetal head. Where the line is present, it may provide a useful guide for clinicians of labour progress along side other measures. Further research is required to assess whether measurement of the line is acceptable to women in labour and also clinicians.

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“…Recently, various attempts have been made to design instruments for improving accuracy of cervical dilatation and fetal head station [29]- [32] measurement, but none of them introduced significant advantages and some showed highly invasiveness for mothers and babies [33]. As opposite, our methodology, tested for labor monitoring on a number of volunteers, resulted well tolerated by the patients.…”

Section: Resultsmentioning

confidence: 95%

Quantitative and automatic echographic monitoring of labor progression

Casciaro

Conversano

Casciaro

et al. 2012

2012 IEEE International Ultrasonics Symposium

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Nowadays the decision between Caesarean Sections (CS), natural or operative child delivery is taken upon interpretation of manually measured anatomical parameters and recorded fetal heart rate, exposing the clinical staff and patients to human errors and determining the continuously rising rate of CS above the ideal 15% recommended by the World Health Organization. This study introduces a new method for noninvasive, quantitative and automatic monitoring of childbirth labor progression. We combined an ultrasound system with a real-time tracking algorithm in order to automatically measure labor progression parameters, like head station, head position, progression angle, based on patient specific anatomical references [Patent no. PCT/EP2009/008321]. A 2D digital echograph connected to a PC for real-time image processing was employed to measure fetal head station (FHS) and progression angle (PA). A quantitative validation study was carried out on a birth simulator, consisting of fetal and maternal mannequins immersed in water. Then, a preliminary intrapartum B-mode imaging study was conducted on patients by means of the developed methods and corresponding algorithms. In the birth simulator, the automatic identification was correct in 98% of the computed images providing high visual reliability for the operator. The average errors (expressed as bias±SD) were 0.8±1.9 mm for FHS and 3°±4° for the PA. Accuracies improve of about 30% by reducing the frame-rate to be processed, i.e. from 1 fps to 0.2 fps, which is still suitable for the purpose. The methodology has been successfully validated in preliminary intrapartum echographic monitoring.

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Inaccuracy in cervical dilatation assessment and the progress of labour monitoring

Cited by 21 publications

References 16 publications

The paradox of vaginal examination practice during normal childbirth: Palestinian women’s feelings, opinions, knowledge and experiences

The paradox of vaginal examination practice during normal childbirth: Palestinian women’s feelings, opinions, knowledge and experiences

The purple line as a measure of labourprogress: a longitudinal study

Quantitative and automatic echographic monitoring of labor progression

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