Clinical Evaluation of Labor and Intrapartum Sonography

  • Thomas Popowski
  • Patrick Rozenberg


Clinical evaluation remains the criterion standard, or more agonistically the gold standard, for managing labor. In the intrapartum period, digital vaginal examination allows the assessment of cervical dilatation as well as both the station and position of the fetal head. Few studies, however, have assessed the accuracy of clinical evaluation of labor. In this chapter, we review the publications that have examined this topic.


Ultrasound Examination Fetal Head Vaginal Examination Digital Examination Ischial Spine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Phelps JY, Higby K, Smyth MH, Ward JA, Arredondo F, Mayer AR (1995) Accuracy and intraobserver variability of simulated cervical dilatation measurements. Am J Obstet Gynecol 173(3 Pt 1):942–945PubMedCrossRefGoogle Scholar
  2. 2.
    Zimerman AL, Smolin A, Maymon R, Weinraub Z, Herman A, Tobvin Y (2009) Intrapartum measurement of cervical dilatation using translabial 3-dimensional ultrasonography: correlation with digital examination and interobserver and intraobserver agreement assessment. J Ultrasound Med 28(10):1289–1296PubMedGoogle Scholar
  3. 3.
    Barbera AF, Imani F, Becker T, Lezotte DC, Hobbins JC (2009) Anatomic relationship between the pubic symphysis and ischial spines and its clinical significance in the assessment of fetal head engagement and station during labor. Ultrasound Obstet Gynecol 33(3):320–325PubMedCrossRefGoogle Scholar
  4. 4.
    ACOG ACoOaG (2000) Committee on Practice Bulletin: operative vaginal delivery. ACOG Practice bulletin 2000:171–178Google Scholar
  5. 5.
    Caldwell W, Moloy H, D’Esopo D (1934) A röentgenologic study of the mechanism of engagement of the fetal head. Am J Obstet Gynecol 28:824–841Google Scholar
  6. 6.
    Calkins L (1939) The etiology of occiput presentations. Am J Obstet Gynecol 37:618–623Google Scholar
  7. 7.
    Sherer DM, Miodovnik M, Bradley KS, Langer O (2002) Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor. Ultrasound Obstet Gynecol 19(3):258–263PubMedCrossRefGoogle Scholar
  8. 8.
    Sherer DM, Miodovnik M, Bradley KS, Langer O (2002) Intrapartum fetal head position II: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the second stage of labor. Ultrasound Obstet Gynecol 19(3):264–268PubMedCrossRefGoogle Scholar
  9. 9.
    Akmal S, Tsoi E, Kametas N, Howard R, Nicolaides KH (2002) Intrapartum sonography to determine fetal head position. J Matern Fetal Neonatal Med 12(3):172–177PubMedCrossRefGoogle Scholar
  10. 10.
    Dupuis O, Ruimark S, Corinne D, Simone T, Andre D, Rene-Charles R (2005) Fetal head position during the second stage of labor: comparison of digital vaginal examination and transabdominal ultrasonographic examination. Eur J Obstet Gynecol Reprod Biol 123(2):193–197PubMedCrossRefGoogle Scholar
  11. 11.
    Souka AP, Haritos T, Basayiannis K, Noikokyri N, Antsaklis A (2003) Intrapartum ultrasound for the examination of the fetal head position in normal and obstructed labor. J Matern Fetal Neonatal Med 13(1):59–63PubMedCrossRefGoogle Scholar
  12. 12.
    Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH (2003) Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 21(5):437–440PubMedCrossRefGoogle Scholar
  13. 13.
    Kreiser D, Schiff E, Lipitz S, Kayam Z, Avraham A, Achiron R (2001) Determination of fetal occiput position by ultrasound during the second stage of labor. J Matern Fetal Med 10(4):283–286PubMedCrossRefGoogle Scholar
  14. 14.
    Chou MR, Kreiser D, Taslimi MM, Druzin ML, El-Sayed YY (2004) Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor. Am J Obstet Gynecol 191(2):521–524PubMedCrossRefGoogle Scholar
  15. 15.
    Rozenberg P, Porcher R, Salomon LJ, Boirot F, Morin C, Ville Y (2008) Comparison of the learning curves of digital examination and transabdominal sonography for the determination of fetal head position during labor. Ultrasound Obstet Gynecol 31(3):332–337PubMedCrossRefGoogle Scholar
  16. 16.
    Malvasi A, Tinelli A, Stark M (2011) Intrapartum sonography sign for occiput posterior asynclitism diagnosis. J Matern Fetal Neonatal Med 24(3):553–554PubMedCrossRefGoogle Scholar
  17. 17.
    Malvasi A, Tinelli A, Brizzi A, Guido M, Laterza F, De Nunzio G, Bochicchio M, Ghi T, Stark M, Benhamou D, Di Renzo GC (2011) Intrapartum sonography head transverse and asynclitic diagnosis with and without epidural analgesia initiated early during the first stage of labor. Eur Rev Med Pharmacol Sci 15(5):518–523PubMedGoogle Scholar
  18. 18.
    Malvasi A, Stark M, Ghi T, Farine D, Guido M, Tinelli A (2012) Intrapartum sonography for fetal head asynclitism and transverse position: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination. J Matern Fetal Neonatal Med 25(5):508–512, Epub 2012 Feb 14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Reproductive Biology and CytogeneticsPoissy-Saint Germain Hospital, University Versailles-St QuentinPoissyFrance
  2. 2.Centre Hospitalier Poissy-Saint-GermainCedex, PoissyFrance

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