الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In an attempt to assess the ability of intrapartum ultrasound to accurately monitor the progress of labor, two hundred pregnant females were recruited for the current work. Patients were in the active phase of the first stage of labor.The majority of patients expressed their discomfort towards per vaginum examination (PV) and considered it worse than translabial ultrasound (U/S).The identification of fetal head position by PV was not possible in 18.5% of all exams, whereas ultrasound was capable of depicting fetal position at all times. ultrasonography can help increase the accuracy of fetal head position assessment during labor, in conditions such as caput succedaneum which may complicate clinical determination. TLUS showed a sensitivity of around 70.5% in detecting intact membranes with a very high specificity (>95%). A statistically significant correlation was found between cervical diameter assessed using PV examination and that using TLUS. The presence of caput succedaneum or intact membranes further enhanced the visualization of the cervix uteri. Clinically assessed cervical dilatation positively correlated to the fetal head station assessed by TLUS during the peak of a uterine contraction.
Progression distance (measured both at rest and at the peak of uterine contraction) differed significantly between patients who delivered vaginally from those by CS. For a cut-off of 20.4mm, the ‘dynamic progression distance’ correctly identified engagement of the fetal head with a sensitivity and specificity of around 92% and 76.1% respectively. Moreover, ‘Dynamic progression distance’ shows a sensitivity of 74.4% and a specificity of nearly 82.9% to correctly classify cases that will deliver vaginally for a cut-off value of 22.3mm.
Angle of progression (measured both at rest and at the peak of uterine contraction) differed significantly between patients who delivered vaginally from those by CS. For a cut-off angle of 112° ,‘dynamic angle of progression’ showed a sensitivity of 85.4% and a specificity of 88.7% to correctly identify cases with engaged fetal head. Also, ‘dynamic angle of progression’ was shown to have a sensitivity of 63.4% and a specificity of 100% in detecting cases that are meant to deliver vaginally, at a cut-off value of 113.2°.
Positive correlation was found between the dynamic progression distance (18) measured by TLUS and the time spent from the TLUS examination till delivery: The more the ‘dynamic progression distance’ increases, the less is the expected time till delivery. Likewise, ‘dynamic angle of progression’ measured by TLUS positively correlated with the time till delivery : The larger the angle, the less will be the remaining time till delivery.