Intrapartum sonography to determine fetal head position

Objective: To investigate the accuracy of intrapartum transvaginal digital examination in defining the position of the fetal head. Patients and methods: In 496 singleton pregnancies in labor at term, the fetal head position was determined by routine transvaginal digital examination by the attending midwife or obstetrician. Immediately before or after the clinical examination, the fetal head position was determined using transabdominal ultrasound by an appropriately trained sonographer who was not aware of the clinical findings. The digital examination was considered to be correct if the fetal head position was within 45° of the ultrasound finding. The accuracy of the digital examination was examined in relation to maternal characteristics and the progress of labor. Results: The position of the fetal head was determined by ultrasound examination in all 496 cases examined. Digital examination failed to define the fetal head position in 166 (33.5%) cases and, in 330 cases where the position was determined, t...