New technologies for managing labor by Dan Farine

Author:Dan Farine [Farine, Dan]
Language: deu
Format: epub
ISBN: 9783110316599
Publisher: De Gruyter
Published: 2015-04-28T00:00:00+00:00

Several large multicenter clinical trials using the LaborPro system have been carried out in the recent years.

The LaborPro system proved to be a reliable and user-friendly tool in assessing fetal head station and position. In a multicenter study (Israel, France, and the USA), Nizard et al. [15] used the system to determine head station and position in 166 patients during labor and compared the results to those obtained by digital vaginal examination. Head station was determined sonographically either by measuring the location of the BPD plane relative to the pelvic inlet or by marking the intersection point between the skull contour and the birth canal projection on the screen. Head position was determined when the operator marked one of several landmarks on the screen, such as BPD, orbits, nasal bridge, or cervical spine, and the system calculated the position relative to the birth canal and projected the reconstructed head on screen. The results of the system were expressed as falling in one of eight sections, each 45° wide. It was technically feasible to determine the head station in all patients using LaborPro. Head station measurements obtained by LaborPro using both methods described above were highly correlated with the transvaginal clinical examination, with absolute difference of 3.5 mm between them. However, the correlation between LaborPro and the clinical examination in assessing the fetal head position was poor, with only 40% agreement between the two methods (Table 5.1), bringing the reliability of the digital examination of fetal head position into question.

LaborPro was used as a reference for in vivo evaluation of the accuracy of 333 cervical dilatation measurements in 188 women in active labor. The mean absolute difference in cervical dilatation between clinical assessment and the LaborPro system measurement with the fingertip-mounted sensor was 10.2 mm. Results show that clinical assessment was least accurate when cervical dilation was between 6 and 8 cm (p<0.002) [16].

Tab. 5.1: Differences in fetal head position assessment between an ultrasound-based system and vaginal examination.

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