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Assessment of labor progress by intrapartum ultrasound: Can it reduce the incidence of chorioamnionitis?

  • Maya Oberman
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Inbal Avrahami
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Noa Lavi Shoseyov
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Amir Kandel
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Alon Ben-Arie
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Miri Sacagiu
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Edi Vaisbuch
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally to this work.
    Roni Levy
    Correspondence
    Corresponding author: Roni Levy, MD, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, 76100, ISRAEL, Tel. +972-8-9441-225 Fax. +972-8-9411-944.
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
    Search for articles by this author
  • Author Footnotes
    ⁎ These authors contributed equally to this work.
Published:November 15, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100817

      Abstract

      Background

      Assessment of labor progress via digital exams is considered the standard of care in most delivery rooms. However, this method can be stressful, painful and imprecise, and multiple exams increase the risk for chorioamnionitis. Intrapartum ultrasound (IPUS) was found to be an objective non-invasive tool to monitor labor progress.

      Objective

      The study aim was to investigate whether, in nulliparous women, the use of IPUS can reduce the rate of intrapartum fever by reducing the number of digital exams.

      Study design

      A prospective, randomized controlled trial in term nulliparas admitted with prelabor rupture of membranes (PROM), induction of labor or in latent phase of labor with a cervical dilation of less than four cm. Women were randomized into one of two arms: 1. Labor progress assessed by ultrasound (US), avoiding digital exams as much as possible; and 2. Control group where labor progress was assessed according to the regular protocol. Prior to the study, all labor ward physicians underwent training in IPUS.

      Results

      Ninety women were randomized to the US group and 92 to the control group. Compared to the control group, the US group had significantly lower rates of intrapartum fever (11.1% vs. 26.1%, p=0.01), clinical chorioamnionitis (3.3% vs. 16.5%, p>0.01) and histologic chorioamnionitis (2.2% vs. 9.8%, p=0.03). The median number of digital exams was significantly lower in the US group (5, IQR 4-6) than in the control group (8, IQR 6-10, p<0.01). The median number of digital exams per hour in the US group was significantly lower than in the control group (0.2 vs. 0.4, p<0.01). The induction rates, time from admission to delivery, mode of delivery, Apgar at five min and NICU admission rates did not differ significantly between the groups.

      Conclusion

      The use of IPUS lessens the total number of digital exams needed to be performed during labor and consequently the incidence of intrapartum fever and chorioamnionitis are reduced. No adverse effects on labor progress and short-term maternal or neonatal outcomes were noted.

      Keywords

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