Sonographic Evaluation of the Mechanism of Active Labor (SonoLabor Study): observational study protocol regarding the implementation of the sonopartogram

Abstract

IntroductionOver the last decades, a large body of literature has shown that intrapartum clinical digital pelvic estimations of fetal head position, station and progression in the pelvic canal are less accurate, compared with ultrasound (US) scan. Given the increasing evidence regarding the advantages of using US to evaluate the mechanism of labour, our study protocol aims to develop sonopartograms for fetal cephalic presentations. They will allow for a more objective evaluation of labour progression than the traditional labour monitoring, which could enable more rapid decisions regarding the mode of delivery.Methods/analysisThis is a prospective observational study performed in three university hospitals, with an unselected population of women admitted in labour at term. Both clinical and US evaluations will be performed assessing fetal head position, descent and rotation. Specific US parameters regarding fetal head position, progression and rotation will be recorded to develop nomograms in a similar way that partograms were developed. The primary outcome is to develop nomograms for the longitudinal US assessment of labour in unselected nulliparous and multiparous women with fetal cephalic presentation. The secondary aims are to assess the sonopartogram differences in occiput anterior and posterior deliveries, to compare the labour trend from our research with the classic and other recent partogram models and to investigate the capability of the US labour monitoring to predict the outcome of spontaneous vaginal delivery.Ethics and disseminationAll protocols and the informed consent form comply with the Ministry of Health and the professional society ethics guidelines. University ethics committees approved the study protocol. The trial results will be published in peer-reviewed journals and at the conference presentations. The study will be implemented and reported in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement.Trial registration numberClinicalTrials.gov Registry (NCT02326077).

Utility of Ultrasonographic Parameters for Monitoring of Progress of Labor and Prediction of Successful Vaginal Delivery: Narrative Review

“…After finalizing the normogram, implementation of sonolabor would be undertaken in a phased manner. 44 An observational prospective cohort study, which is recruiting 4,000 participants for assessing the progress of labor clinically and by USG, also aims to find out the psychological impact of labor monitoring by USG. The trial (ClinicalTrials.gov Identifier: NCT02326077) ends in October 2023.…”

How to Reach the Best Ultrasound Performance in the Delivery Room

“…A different use of ultrasound during the labor is by creating a sonopartogram, which is a conformation of the conventional partogram, with the use of ultrasound parameters of recording assessments during the labor. 69 70 It is possible to evaluate cervical dilatation, fetal head rotation, and fetal head descent, as it is in the conventional partogram, as well as to evaluate caput and molding 69 70 ( Figure 3 ). Although a good agreement was shown between VE and ultrasound evaluation regarding cervical dilatation and head rotation during the first period of labor, the evaluation of head descent was better estimated by VE.…”