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Assessment of labor progress by ultrasound vs manual examination: a randomized controlled trial

  • Maya Oberman
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Inbal Avrahami
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
    Search for articles by this author
  • Noa Lavi Shoseyov
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Amir Kandel
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Alon Ben-Arie
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
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  • Miri Sacagiu
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with 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
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with 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.
    Footnotes
    ⁎ These authors contributed equally to this work.
    Affiliations
    From the Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, affiliated with 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

      BACKGROUND

      Assessment of labor progress via digital examination is considered the standard of care in most delivery rooms. However, this method can be stressful, painful, and imprecise, and multiple examinations increase the risk for chorioamnionitis. Intrapartum ultrasound was found to be an objective, noninvasive tool to monitor labor progression.

      OBJECTIVE

      This study aimed to investigate whether, among nulliparous women, the use of intrapartum ultrasound can reduce the rate of intrapartum fever by reducing the number of digital examinations.

      STUDY DESIGN

      This was a prospective, randomized controlled trial in term nulliparas admitted with prelabor rupture of membranes, induction of labor, or in latent phase of labor with a cervical dilation of <4 cm. Women were randomized into 1 of the following 2 arms: (1) labor progress assessed by ultrasound, avoiding digital examinations as much as possible; and (2) control group in which labor progression was assessed according to the regular protocol. Before the study, all labor ward physicians underwent training in intrapartum ultrasound.

      RESULTS

      A total of 90 women were randomized to the ultrasound group and 92 were randomized to the control group. When compared with the control group, the ultrasound group had significantly lower rates of intrapartum fever (11.1% vs 26.1%; P=.01), clinical chorioamnionitis (3.3% vs 16.5%; P>.01), and histologic chorioamnionitis (2.2% vs 9.8%; P=.03). The median number of digital examinations was significantly lower in the ultrasound group (5; interquartile range, 4–6) than in the control group (8; interquartile range, 6–10; P<.01). The median number of digital examinations per hour in the ultrasound group was significantly lower than in the control group (0.2 vs 0.4; P<.01). The induction rates, time from admission to delivery, mode of delivery, Apgar score at 5 minutes, and neonatal intensive care unit admission rates did not differ significantly between the groups.

      CONCLUSION

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

      Key words

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