Fetal and Maternal Imaging: Ultrasound Assessment of Labor Parameters

Today antenatal ultrasound is a necessary tool for screening and diagnosis of pregnancy. It is extensively used for fetal chromosomal risk assessment, fetal anatomy and biometry, placental localization and fetal head presentation in singleton and multiple pregnancies. It is essential for intrauterine invasive procedures and for the management of growth restricted fetuses. Ultrasound during labor or "Intrapartum Ultrasound" has been explored widely in the last decade for the assessment of fetal presentation, fetal heart beat localization and more recently in advanced research topics such as monitoring the progress of labor and prediction of mode of delivery. The overall concept of this thesis was to describe new methods of assessment of parameters of labor by ultrasound. For this purpose, we performed an observational study investigating the use of a novel method for assessing cervical dilatation by ultrasound during labor; a novel method for monitoring the progress of labor "sonopartogram"; assessment of caput succedaneum by transperineal ultrasound and furthermore to analyze the parameters of labor by ultrasound in prediction of mode of delivery. In addition to the above methods we will give an insight on the current established methods for assessment of the progress of labor and will compare these methods to ultrasound. We applied innovative use of technology such as transperineal ultrasound in monitoring labor progress. Obstetrics has the opportunity to develop into an objectively guided skill. Assessment of fetal head descent no longer needs to rely on an imaginary line drawn between the ischial spines; cervical dilatation could be measured accurately using simple two-dimensional (2D) ultrasound. Monitoring the progress of labor has the opportunity to be performed solely by the means of 11 ultrasound. Labor characteristics such as head descent, head rotation, caput succedaneum, cervical dilatation when measured by ultrasound could predict the outcome of delivery (i.e. vaginal or caesarean delivery) in women with prolonged labor.