Intrapartum sonographic signs: new diagnostic tools in malposition and malrotation

Abstract

In the past years, numerous studies have been published on the use of ultrasound during labor, showing this is an effective, accurate and objective tool for the assessment of the fetal head position and station. Literature affirmed that traditional transvaginal digital examination is highly subjective and dependent on the operator's experience. On the contrary, the use of intrapartum suprapubic transabdominal ultrasound can improve accuracy in determination of fetal head position and the precise knowledge of the location of specific fetal head landmarks in relationship to maternal pelvis. Intrapartum ultrasound will assist obstetricians in the diagnosis of normal labor progression, suggesting when medical and or operative intervention should be taken in case of complications. During each fetal head movement, there is a very specific relationship between fetal head landmarks and well-identified maternal structures, so the ultrasound diagnosis is performed step by step. In this review, we summarized the clinical situation of the fetal head in the pelvis and the relative ultrasonographic signs. Moreover, we collected all the ultrasonographic measures to diagnose the fetal head progression and rotations in the birth canal.

Sonographic evaluation of the fetal spine position and success rate of manual rotation of the fetus in occiput posterior position: A randomized controlled trial

“…US examination was performed using a GE Logiq P5 scanner (GE Healthcare Italia) equipped with a convex 2–5‐MHz transducer. The transabdominal US signs considered for the OPP diagnosis were the fetal orbits, orbicular muscles, and nasal bridge sign . The fetal spine position (described as anterior, lateral right, lateral left, or posterior) was determined in all the patients using transabdominal US scan performed before the manual rotation.…”

Fetal molding examined with transperineal ultrasound and associations with position and delivery mode

“…Ultrasound has a potential to improve knowledge about the labor process, and editorials and opinions in scientific journals have promoted increased use of ultrasound in active labor [18][19][20][21] . Fetal position 22,23 ; fetal presentation 24,25 , fetal station [26][27][28][29] , fetal attitude can be measured 30,31 and the clinical feasibility has been studied in many publications 23,28,[32][33][34][35][36][37][38][39][40][41][42] .…”

Intrapartum ultrasound: viewpoint of midwives and parturient women and reproducibility

“…Measurements for dilation, effacement, position and descent of the fetal head have been developed. 2 , 3 , 5 , 6 Ultrasound during labor has been proven to be able to predict labor outcomes in primiparous women with prolonged first stage of labor. 7 Moreover, intrapartum ultrasound evaluation is superior to VE in terms of identifying the correct fetal head position.…”