الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Traditional obstetrics emphasizes the role of digital examinations, but recent studies have demonstrated that this approach is inaccurate and subjective with a rate of error ranging from 20% to 70%, and that intrapartum ultrasound is far more precise.
Intrapartum ultrasound has been explored in the last decade, from simple uses such as determination of fetal presentation and identifying the fetal heart beat during labor to advanced topics like assessment of fetal head engagement, descent and rotation for prediction of the mode of delivery.
The aim of this study was to assess the ability of intrapartum trans-labial ultrasound to objectively predict successful vaginal birth in ladies with previous caesarean section.
This study was carried out on 200 pregnant women at term singleton gestation, admitted to the labor ward with spontaneous onset of labor. All of them were in the active phase of the first stage of labor, and had previous caesarean section delivery. TLUS was done measuring the angle of fetal head progression, and the progression distance of fetal head.
VBAC was successful in 24.5% of cases. Trial of labor after Cesarean section (TOLAC) ended by CS delivery in 75.5% of cases. At a cut-off value 2.5mm the sensitivity of the progression distance “PD” was 89.3% and specificity was 71.4% in prediction of vaginal delivery. The angle of progression ‘AoP’ at a cut-off value of 100.5 degrees had sensitivity of 88.5% and specificity of 74.3% in prediction of VBAC.
There was strong correlation between both wider angle of progression and longer progression distance with occurrence of VBAC. And shorter time interval to delivery.
Other factors such as Bishop score, history of previous normal delivery, and the indication of previous Cs, had significant impact on mode of delivery.
TLUS was found to be more tolerated and accepted by most of cases regardless the mode of delivery.