Ultrasonografia na sali porodowej – fanaberia czy konieczność?

• Authors: Marzena Dębska , Piotr Kretowicz , Romuald Dębski

Title variants

EN

Intrapartum sonography – eccentricity or necessity?

• Languages of publication: EN PL

Abstracts

EN

Ultrasonography has been extensively used in obstetrics and gynecology since 1980’s. It found application in pediatric gynecology, procreation period, post-menopause, pregnancy monitoring and after delivery. Although the first reports on the use of ultrasonography in assessing delivery mechanism were published in 1990’s, yet to date labor progress is evaluated by means of physical examination in most delivery units. Intrapartum sonography is not routinely performed despite the fact that numerous studies documented high error rates of conventional obstetrical examination. Even an experienced physician makes a mistake in every third case of the fetal head descent and fontanelle position assessment. Nowadays, obstetrician’s role is not to strain for vaginal delivery at all costs, but to provide the patient in labor and her newborn with maximal safety. To achieve this objective, an obstetrician should distinguish between women who will deliver spontaneously and whose who require Cesarean section. Proper decision should be made on the basis of objective and valid evaluation of obstetric setting, which cannot be achieved solely with physical examination. Intrapartum sonography was shown to be far more accurate than digital examination. Moreover, it is not technically demanding, provides high reproducibility and neither increases the rate of ascending infection or causes discomfort to the patient. Current research suggests that if used routinely, intrapartum sonography can increase the safety of labor and reduce cesarean section rate.

PL

Diagnostyka ultrasonograficzna jest powszechnie stosowana w położnictwie i ginekologii od lat 80. ubiegłego wieku. Badania ultrasonograficzne wykonuje się w ginekologii dziecięcej, w okresie prokreacyjnym, po menopauzie, w monitorowaniu przebiegu ciąży i po porodzie. Pierwsze doniesienia o wykorzystaniu ultrasonografii do oceny mechanizmu porodowego pojawiły się w latach 90., jednak do dziś w większości ośrodków postęp porodu oceniany jest wyłącznie w badaniu klinicznym. Nie wykonuje się śródporodowego badania ultrasonograficznego, mimo że w wielu pracach wykazano, że tradycyjne badanie położnicze cechuje się wysokim odsetkiem błędów. Nawet doświadczony lekarz, oceniając zaawansowanie głowy w kanale rodnym i lokalizację ciemiączek, myli się w tym badaniu przeciętnie w co trzecim przypadku. Obecnie rola położnika nie polega na dążeniu za wszelką cenę do ukończenia porodu drogami natury, lecz na zapewnieniu maksymalnego bezpieczeństwa rodzącej i jej dziecku. Aby je zapewnić, położnik powinien określić, które pacjentki mają szansę urodzić drogami natury, a u których lepszym rozwiązaniem będzie wykonanie cięcia cesarskiego. Właściwa decyzja może zostać podjęta jedynie na podstawie obiektywnej i prawidłowej oceny sytuacji położniczej, co nie jest możliwe jedynie na podstawie samego badania klinicznego. Wykazano, że badanie ultrasonograficzne w czasie porodu jest znacznie bardziej wiarygodne niż badanie palpacyjne. Ponadto jest proste technicznie, powtarzalne, nie zwiększa ryzyka infekcji wstępującej i nie powoduje dyskomfortu dla pacjentki. Dotychczasowe wnioski wynikające z prac naukowych oceniających zastosowanie ultrasonografii w trakcie porodu są bardzo optymistyczne i wskazują, że jej wprowadzenie może wpłynąć na zwiększenie bezpieczeństwa porodu, a nawet na zmniejszenie odsetka cięć cesarskich.

Keywords

EN

angle of progression; badanie palpacyjne; digital examination; fetal head descent; intrapartum ultrasound; kąt progresji; ultrasonografia śródporodowa; zstępowanie głowy

Discipline

• MEDICINE: MEDICINE

• Journal: Journal of Ultrasonography
• Year: 2015
• Volume: 15
• Issue: 61
• Pages: 125-136

Contributors

author

Marzena Dębska

• MD, PhD, II Department of Obstetrics and Gynaecology, The Medical Centre of Postgraduate Education, Bielański Hospital, Warsaw, Poland, Cegłowska 80, 01-001 Warsaw, Poland, tel.: [phone],

author

Piotr Kretowicz

• II Department of Obstetrics and Gynaecology, The Medical Centre of Postgraduate Education, Warsaw, Poland

author

Romuald Dębski

• II Department of Obstetrics and Gynaecology, The Medical Centre of Postgraduate Education, Warsaw, Poland

References

• 1. Hayachi RH: Ultrasound uses in obstetrics. Clin Perinatol 1983; 10: 253–261.
• 2. Akmal S, Tsoi E, Kametas N, Howard R, Nicolaides KH: Intrapartum sonography to determine the fetal head position. J Matern Fetal Neonatal Med 2002; 12: 172–177.
• 3. Sherer DM, Miodovnik M, Bradley KS, Langer O: Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor. Ultrasound Obstet Gynecol 2002; 19: 258–263.
• 4. Sherer DM, Miodovnik M, Bradley KS, Langer O: Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor. Ultrasound Obstet Gynecol 2002; 19: 264–268.
• 5. Souka AP, Haritos T, Basayiannis K, Noikokyri N, Antsaklis A: Intrapartum ultrasound for the examination of the fetal head position in normal and obstructed labor. J Matern Fetal Neonatal Med 2003;13: 59–63.
• 6. Dupuis O, Silveira R, Zentner A, Dittmar A, Gaucherand P, Cucherat M et al.: Birth simulator: reliability of transvaginal assessment of fetal head station as defi ned by the American College of Obstetricians and Gynecologists classifi cation. Am J Obstet Gynecol 2005; 192: 868–874.
• 7. Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH: Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003; 21: 437–440.
• 8. Sherer DM, Onyeije CI, Bernstein PS, Kovacs P, Manning FA: Utilization of real-time ultrasound on labor and delivery in an active academic teaching hospital. Am J Perinatol 1999; 16: 303–307.
• 9. Chou MR, Kreiser D, Taslimi MM, Druzin ML, El-Sayed YY: Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 2004; 191: 521–524.
• 10. Akmal S, Tsoi E, Nicolaides KH: Intrapartum sonography to determine fetal occipital position: interobserver agreement. Ultrasound Obstet Gynecol 2004; 24: 421–424.
• 11. Rozenberg P, Porcher R, Salomon LJ, Boirot F, Morin C, Ville Y: Comparison of the learning curves of digital examination and transabdominal sonography for the determination of fetal head position during labor. Ultrasound Obstet. Gynecol. 2008; 31: 332–337.
• 12. Barbera AF, Pombar X, Perugino G, Lezotte DC, Hobbins JC: A new method to assess fetal head descent in labor with transperineal ultrasound. Ultrasound Obstet Gynecol 2009; 33: 313–319.
• 13. Dückelmann AM, Bamberg C, Michaelis SA, Lange J, Nonnenmacher A, Dudenhausen JW, Kalache KD: Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise. Ultrasound Obstet. Gynecol. 2010; 35: 216–222.
• 14. Tutschek B, Torkildsen EA, Eggebø TM: Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor. Ultrasound Obstet Gynecol 2013; 41: 425–429.
• 15. Henrich W, Dudenhausen J, Fuchs I, Kämena A, Tutschek B: Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction. Ultrasound Obstet Gynecol 2006; 28: 753–760.
• 16. Eggebø TM, Hassan WA, Salvesen KÅ, Lindtjørn E, Lees CC: Sonographic prediction of vaginal delivery in prolonged labor: a two-center study. Ultrasound Obstet Gynecol 2014; 43: 195–201.
• 17. Torkildsen EA, Salvesen KÅ, Eggebø TM: Prediction of delivery mode with transperineal ultrasound in women with prolonged fi rst stage of labor. Ultrasound Obstet. Gynecol. 2011; 37: 702–708.
• 18. Ghi T, Youssef A, Maroni E, Arcangeli T, De Musso F, Bellussi F et al.: Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery. Ultrasound Obstet Gynecol 2013; 41: 430–435.
• 19. Cuerva MJ, Bamberg C, Tobias P, Gil MM, De La Calle M, Bartha JL: Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position. Ultrasound Obstet Gynecol 2014; 43: 687–692.
• 20. Youssef A, Maroni E, Ragusa A, De Musso F, Salsi G, Iammarino MT et al.: Fetal head-symphysis distance: a simple and reliable ultrasound index of fetal head station in labor. Ultrasound Obstet Gynecol 2013; 41: 419–424.
• 21. Ghi T, Maroni E, Youssef A, Morselli-Labate AM, Paccapelo A, Montaguti E: Sonographic pattern of fetal head descent: relationship with duration of active second stage of labor and occiput position at delivery. Ultrasound Obstet Gynecol 2014; 44: 82–89.
• 22. Eggebø TM, Heien C, Økland I, Gjessing LK, Romundstad P, Salvesen KA: Ultrasound assessment of fetal head-perineum distance before induction of labor. Ultrasound Obstet Gynecol 2008; 32: 199–204.
• 23. Ghi T, Farina A, Pedrazzi A, Rizzo N, Pelusi G, Pilu G: Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound. Ultrasound Obstet Gynecol 2009; 33: 331–336.
• 24. Hassan WA, Eggebø TM, Ferguson M, Lees C: Simple two-dimensional ultrasound technique to assess intrapartum cervical dilatation: a pilot study. Ultrasound Obstet Gynecol 2013; 41: 413–418.
• 25. Gilboa Y, Kivilevitch Z, Spira M, Kedem A, Katorza E, Moran O et al.: Pubic arch angle in prolonged second stage of labor: clinical signifi - cance. Ultrasound Obstet Gynecol 2013; 41: 442–446.
• 26. Blasi I, D’Amico R, Fenu V, Volpe A, Fuchs I, Henrich W et al.: Sonographic assessment of fetal spine and head position during the fi rst and second stages of labor for the diagnosis of persistent occiput posterior position: a pilot study. Ultrasound Obstet Gynecol 2010; 35: 210–215.
• 27. Gilboa Y, Kivilevitch Z, Spira M, Kedem A, Katorza E, Moran O et al.: Head progression distance in prolonged second stage of labor: relationship with mode of delivery and fetal head station. Ultrasound Obstet Gynecol 2013; 41: 436–441.
• 28. Hassan WA, Eggebø T, Ferguson M, Gillett A, Studd J, Pasupathy D et al.: The sonopartogram: a novel method for recording progres of labour by ultrasound. Ultrasound Obstet Gynecol 2014; 43: 189–194.
• 29. Cunningham F, Leveno KJ, Bloom SI, Hauth JC, Gilstrap JC (eds.): Williams Obstetrics. Vol. 1, McGraw-Hill 2005; 15–38.
• 30. Dückelmann AM, Michaelis SA, Bamberg C, Dudenhausen JW, Kalache KD: Impact of intrapartal ultrasound to assess fetal head position and station on the type of obstetrical interventions at full cervical dilatation. J Matern Fetal Neonatal Med 2012; 25: 484–488.

• Document Type: article