Impact of ultrasound guided training in the diagnosis of the fetal head position during labor: A prospective observational study

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 256; pp. 308 - 313
• Main Authors: Ramirez Zegarra, Ruben, di Pasquo, Elvira, Dall’Asta, Andrea, Minopoli, Monica, Armano, Giulia, Fieni, Stefania, Frusca, Tiziana, Ghi, Tullio
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2021
• Subjects: Female; Fetal head position; Fetus; Head - diagnostic imaging; Humans; Intrapartum ultrasound; Labor Presentation; Pregnancy; Residents; Ultrasonography, Interventional; Ultrasonography, Prenatal; Ultrasound training; Vaginal examination; LOT; Intrapartum ultrasound; OP; OA; Ultrasound training; OT; ROT; Fetal head position; HPD; Residents; Vaginal examination
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2020.11.053

•Intrapartum ultrasound is becoming increasingly an important tool in the labor ward, especially when dealing with protracted labor or before performing an operative vaginal delivery.•Transvaginal digital examination is a particularly important skill in the labor ward, and it is an important feature during a resident’s training.•Improving transvaginal digital examination skills can be exceedingly difficult, given the fact that its accuracy ranges between 20 and 70 % even among experienced obstetricians. Therefore, the use of ultrasound could help to improve this learning curve of the transvaginal digital examination. To assess whether the additional training with transabdominal ultrasound may improve the accuracy of the transvaginal digital examination in the assessment of the fetal head position during the active stage of labor. Prospective observational study involving 2 residents in their 1 st year of training in Obstetrics with no prior experience in neither transvaginal digital examination nor ultrasound. Women with term, cephalic presenting fetus and active labor with cervical dilation ≥ 8 cm and ruptured membranes were included. In the preliminary phase of the study, the resident A (“blinded”) was assigned to assess the fetal head position by transvaginal digital examination, while the resident B (“unmasked”) performed transvaginal digital examination following transabdominal ultrasound, which was considered to be the gold standard to determine the fetal head position. After 50 examinations independently performed by each resident in the training phase, a post-training phase of the study was carried out to compare the accuracy of each resident in the diagnosis of fetal head position by digital assessment. The occiput position was eventually confirmed by ultrasound performed by the main investigator. Over a 6 months period, 90 post-training vaginal examinations were performed by each resident. The number of incorrect diagnoses of head position was higher for the “blinded” resident compared with the “unmasked” resident subjected to the ultrasound training (28/90 or 31.1 % vs 15/90 or 16.7 % p = 0.02). For both residents a wrong diagnosis was more likely with non-OA vs OA fetuses but this difference was statistically significant for the “blinded” Resident (10/20 or 50 % vs 18/70 or 25.7 % p = 0.039) but not for the “unmasked” Resident (5/18 or 27.9 % vs 10/72 or 13.9 % p = 0.16). The addition of transabdominal ultrasound as a training tool in the determination of the fetal head position during labor seems to improve the accuracy of the transvaginal digital examination in unexperienced residents.