Role of US in labour ward

Role of Ultrasonography in Labour WardDr/ Mahmoud Abdel-AleemAssistant Professor of Obstetrics and Gynecology

introduction

Extensive evidence over the last 30 years has demonstrated the value of ultrasound in the prenatal fetal assessment (anatomy, physiology and pathology): Antepartum Sonography

Over the last 10 years, recent studies suggest that ultrasound may play an important role in the prediction of the time of onset and the progress of labor: Intrapartum Sonography (IPS)

What do we need to learn?Is it the emergency obstetric care unit ?

Is it the labour ward?

Is it the delivery room?

Basics of intrapartum sonography

Machine: simple 2-D machine can be used satisfactorilyProbe: abdominal probe with a frequency 3.5-5.5 MHzRoute: Abdominal.Trans-perineal (translabial).

Technique of ips

A- Transabdominal IPS

TechniqueMaternal position: supineTransducer position: transverse on the suprapubic region of the maternal abdomenLandmarks:The foetal orbits.Midline cerebral echo.Cerebellum.

B- Trans-labial (TRANS-PERINEAL) US

Technique Position: supineTransducer: place a covered transabdominal transducer on the perineum in a mid-sagittal position between the labia below the pubic symphysis.Manipulate the probe by small lateral movements until an image is obtained that visualizes clearly symphysis pubis and fetal skull with no shadows from pubic rami.Landmarks:The foetal orbits: occipto-posteriorMidline cerebral echo: occipto-transverse.Cerebellum: occipto-anterior

Objective value of ips

Three Practical measures that are measurable and reproducible !!Progression distance:.

Fetal head direction:

Angle of progression:

I. Progression DistanceDistance from the lowest part of the fetal skull related to a line perpendicular to the inferior border of the symphysis pubis

Progression Distance

II. Fetal Head DirectionAssesses the direction of the fetal head related to same line

Downward direction

Horizontal direction

Upward Direction

III. ANGLE OF PROGRESSIONAssesses the angle between the pubic symphysis and a line tangential to the skull contour.

Angle of progression

Angle of Progression

Angle of the Middle line of head

Some images

Head engagement

In (a) the transducer is angled cephalad to the maternal sacral promontory (