Reliability and Reproducibility of Analyzing 3D Transperineal Ultrasound Volumes Obtained in the First Phase of Labor - A Pilot Study

Abstract

Purpose The aim of this study was to investigate the reliability and reproducibility of transperineal ultrasound (TPUS) in the initial phase of labor. As TPUS is a common method, it could supplement vaginal palpation and even replace it in certain situations. In addition, we used a 4-dimensional method for the assessment of cervical effacement.

Materials and Methods 54 women in labor were included and underwent TPUS. The resulting images from the acquired 4D volumes were evaluated after the examination for the first time and a second time after 21 days. The measured values were cervical length, dilatation and effacement, the angle of progression (AoP), and head-perineum distance.

Results 54 patients were examined. TPUS images were unable to be evaluated in 12 patients because of cervical dilatation of more than 5 cm or poor image quality. Thus, 42 measurements were included. The concordance correlation coefficients according to Lin are satisfactory overall, with one exception for cervical effacement. The accuracy component of cervical length (CCC_Lin: 0.93; accuracy: 1.00), dilatation (CCC_Lin: 0.93; accuracy: 1.00), and AoP (CCC_Lin: 0.87; accuracy: 1.00) is excellent and still high for the head-perineum distance (CCC_Lin: 0.89; accuracy: 0.96) and cervical effacement (CCC_Lin: 0.77; accuracy: 0.97).

Conclusion TPUS is a valuable noninvasive tool with good diagnostic accuracy for the AoP, cervical length, and dilatation. Our study provides support for the use of TPUS to complement a vaginal examination. It should not replace a digital examination but should serve as a suitable alternative method for monitoring labor progression in the future.

Zusammenfassung

Ziel Ziel dieser Studie ist es, die Zuverlässigkeit und Reproduzierbarkeit des transperinealen Ultraschalls (TPUS) subpartu zu untersuchen. Als gängige Methode könnte diese die vaginale Palpation ergänzen und in bestimmten Situationen sogar ersetzen. Darüber hinaus haben wir eine 4-dimensionale Methode zur Beurteilung der Zervixreife eingesetzt.

Material und Methode Es wurden 54 Frauen subpartu eingeschlossen, die sich einem TPUS unterzogen. Das resultierende Ultraschallbild aus dem erfassten 4D-Volumen wurde nach der Untersuchung zum ersten Mal und ein zweites Mal nach 21 Tagen ausgewertet. Gemessen wurden die Cervixlänge, -Dilatation und Reife sowie der Progressionswinkel (AoP) und der Kopf-Perineum-Abstand.

Ergebnisse Es wurden 54 Frauen untersucht. 42 Messungen wurden in die Auswertung einbezogen (schlechte Bildqualität bzw. Muttermundöffnung > 5 cm bei 12 Patientinnen). Die Konkordanz-Korrelationskoeffizienten nach Lin sind mit Ausnahme für die Zervixreife insgesamt zufriedenstellend. Die accuracy (Genauigkeit) der Zervixlänge (CCC_Lin: 0,93; accuracy:1,00), der Dilatation (CCC_Lin: 0,93; accuracy: 1,00) und des AoP (CCC_Lin: 0,87; accuracy: 1,00) ist ausgezeichnet, für den Kopf-Perineum-Abstand (CCC_Lin: 0,89; accuracy: 0,96) und die Zervixreife (CCC_Lin: 0,77; accuracy: 0,97) adäquat.

Schlussfolgerung TPUS ist ein wertvolles nicht-invasives Instrument mit einer guten diagnostischen Genauigkeit in Bezug auf die Zervixlänge, -dilatation und den AoP. Unsere Studie unterstützt den Einsatz des Ultraschalls als Ergänzung zur vaginalen Untersuchung. In Zukunft könnte der TPUS eine geeignete alternative Methode zur Überwachung des Geburtsfortschritts sein.

Keywords

Bishop Score - reliability - reproducibility - transperineal ultrasound

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