Intrapartum ultrasound during prolonged second stage of labor: a diagnostic tool suggested for operative delivery to reduce complications.

Abstract

Diagnosis and management of prolonged second stage of labor and its complications is difficult and often poses a dilemma to the treating obstetrician regarding timing and type of intervention. Nowadays, the diagnosis of dys-tocic prolonged second stage of labor is largely based on digital evaluation of cervical dilatation and fetal head station and position, resulting inaccurate and subjective. Moreover, the problem of timing of delivery for nullipa-ra during dystocic labor and labor analgesia is clinically unsolved, as well as questioned since many years. Thus, labor management is largely based upon clinical and not instrumental findings. Women in dystocic labor require, often, operative delivery, after many hours of pain during labor. Accurate assessment of fetal head position and station is crucial in clinical decision-making during the second stage of labor and the fetal station was misinter-preted as lower than it really was in 15–22% of cases. Misdiagnosis or failure to correctly identify the fetal head position and station is one of the causes of failed instrumental delivery and subsequently of higher rate of neona-tal morbidity. Intrapartum ultrasound also distinguishes patients destined for spontaneous vaginal delivery from those to submit to operative delivery. The intrapartum US is an adjunctive tool for labor ward obstetricians in the management of prolonged second stage and dystocia. It is a more objective and reliable tool than digital ex-amination, and may give the obstetrician a more accurate perspective before making crucial clinical decisions re-garding the chances of a successful vaginal delivery, and may lower the rate of failed instrumental delivery and its associated morbidity.