Comparison between Intrapartum Ultrasound and Postdelivery Measurement of Head Circumference in Prediction of Second Stage Duration of Labor in Nulliparous Women
Abstract
ABSTRACT
Background: Digital assessment of fetal head station during labor is a subjective tool,
prone to considerable disagreement among examiners. Nulliparous mothers of large-fetal
head circumference infants are at increased risk of primary cesarean section and
operative vaginal delivery. Intrapartum ultrasonography has enabled further understanding
of the complex physiology of childbirth. It has been shown to provide objective information
on the dynamics of different stages of labor.
Objectives: To assess the usefulness of intrapartum ultrasound to predict the duration of
second stage of labour in nulliparous women by measuring fetal head circumference and
also to assess head circumference post-delivery and second stage duration.
Methods: This cross sectional study was carried out between 1st of January 2014 and 1st
of june2014 at Baghdad Teaching Hospital. In the current study, 70 nulliparous women
were admitted to the labour ward complaining of labour pain with cervical dilatation 4 cm
and above. The intrapartum fetal head circumference was measured for all women
involved in the study by ultrasound plus estimation of 2nd stage duration. Measurement of
fetal head circumference after delivery by tape measure was done and the relationship
between the circumference after delivery and duration of second stage of labour was
assessed and between the circumference by ultrasound and second stage duration also
assessed.
Results: There were 70 women enrolled in this study with a mean age of 21.7 ± 4.1
(range 14-30) years. The mean head circumference of the neonates according to the
ultrasound was 33.9 ± 1.5 (ranged 31-37) cm and after labor was 35.1 ± 1.5 (range 31.5-
38) cm. The mean time period of the second stage of labor was 25.1 ± 16.5 min with a
range of 5-90 min and by statistical analysis, it had been significantly found that the mean
time of 2nd stage of labor increased with the larger head circumference.
Conclusion: Head circumference measured by intrapartum ultrasonography is a good
predictor for the duration of second stage of labor and duration of 2nd stage of labor
decreased with smaller fetal head circumference and vice versa.
Keywords: Head circumflex, Second stage of labor, Ultrasound measurement.
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