Intrapartum ultrasound assessment of cervical dilatation and its value in detecting active labor

Journal article


Whitehead, B. 2018. Intrapartum ultrasound assessment of cervical dilatation and its value in detecting active labor. Journal of Ultrasound. https://doi.org/10.1007/s40477-018-0309-2
AuthorsWhitehead, B.
Abstract

Introduction We aimed to examine the agreement between ultrasound and digital vaginal examination in assessing cervical dilatation in an African population and to assess the value of ultrasound in detecting active labor. Method A cross-sectional study was conducted in a teaching hospital in Ghana between April and September of 2016. Anterior–posterior and transverse diameters of cervical dilatation were measured with ultrasound and the mean value was compared with digital vaginal examination in 195 women in labor. Agreement between methods was examined with correlation coefficients and with Bland–Altman plots. Active labor was defined when cervix was dilated ≥ 4 cm with vaginal examinations. ROC curve analysis was conducted on the diagnostic performance of ultrasound in detecting active labor. Results Data were analyzed in 175 out of 195 (90%) cases where ultrasound could clearly visualize the cervix. The remaining 20 cases were all determined by digital vaginal examination as advanced cervical dilatation (≥ 8 cm), advanced head station (≥ + 2), and with ruptured membranes. The Pearson correlation coefficient (r) was 0.78 (95% CI 0.72–0.83) and the intra-class correlation coefficient was 0.76 (95% CI 0.69–0.81). Bland–Altman analysis obtained a mean difference of − 0.03 cm (95% CI − 0.18 to 0.12) with zero included in the CI intervals, indicating no significant difference between methods. Limits of agreement were from − 2.01 to 1.95 cm. Ultrasound predicted active labor with 0.87 (95% CI 0.75–0.99) as the area under the ROC curve. Conclusion Ultrasound measurements showed good agreement with digital vaginal examinations in assessing cervical dilatation during labor and ultrasound may be used to detect active labor.

Introduction We aimed to examine the agreement between ultrasound and digital vaginal examination in assessing cervical dilatation in an African population and to assess the value of ultrasound in detecting active labor.
Method A cross-sectional study was conducted in a teaching hospital in Ghana between April and September of 2016.
Anterior–posterior and transverse diameters of cervical dilatation were measured with ultrasound and the mean value was
compared with digital vaginal examination in 195 women in labor. Agreement between methods was examined with correlation
coefficients and with Bland–Altman plots. Active labor was defined when cervix was dilated ≥ 4 cm with vaginal
examinations. ROC curve analysis was conducted on the diagnostic performance of ultrasound in detecting active labor.
Results Data were analyzed in 175 out of 195 (90%) cases where ultrasound could clearly visualize the cervix. The remaining
20 cases were all determined by digital vaginal examination as advanced cervical dilatation (≥ 8 cm), advanced head
station (≥ + 2), and with ruptured membranes. The Pearson correlation coefficient (r) was 0.78 (95% CI 0.72–0.83) and
the intra-class correlation coefficient was 0.76 (95% CI 0.69–0.81). Bland–Altman analysis obtained a mean difference of
− 0.03 cm (95% CI − 0.18 to 0.12) with zero included in the CI intervals, indicating no significant difference between methods.
Limits of agreement were from − 2.01 to 1.95 cm. Ultrasound predicted active labor with 0.87 (95% CI 0.75–0.99) as
the area under the ROC curve.
Conclusion Ultrasound measurements showed good agreement with digital vaginal examinations in assessing cervical
dilatation during labor and ultrasound may be used to detect active labor.

KeywordsCervical dilatation; Pregnancy; Transperineal ultrasound; Vaginal examination; Ultrasound; Labour
Year2018
JournalJournal of Ultrasound
PublisherSpringer
ISSN18767931
Digital Object Identifier (DOI)https://doi.org/10.1007/s40477-018-0309-2
Web address (URL)http://hdl.handle.net/10545/622917
http://creativecommons.org/licenses/by/4.0/
hdl:10545/622917
Publication dates2018
Publication process dates
Deposited20 Aug 2018, 15:51
Accepted22 Jun 2018
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ContributorsUniversity of Derby, Kwame Nkrumah University of Science and Technology, Trondheim University Hospital, Norwegian University of Science and Technology and Stavanger University Hospital
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