title: Ultrasound imaging in prolonged second stage of labor: does it reduce the operative delivery rate?
abstract: OBJECTIVE
  To reduce the operative delivery rate in the prolonged second stage of labor (PSSL) through intrapartum sonography.
  
  
  METHODS
  Sixty-two women - with uncomplicated pregnancies at term, fetus in cephalic presentation and occipitoanterior position, in PSSL - had already undergone epidural anesthesia and oxytocin infusion. Transperineal ultrasound was performed to define fetal head direction (downward, horizontal, and upward) and patients were divided into three groups (D, H, and U). PROPOSED PROTOCOL: Cessation of oxytocin infusion, addition of a dose of anesthesia, invitation to assume a hand-and-knee position, and to relax. After one hour, oxytocin infusion was started again and women were invited to push. Fetal well-being ensured by cardiotocography (CTG). Chi-square test was used to compare the mode of delivery: cesarean section (CS), vacuum extraction (VE), and spontaneous delivery (SD).
  
  
  RESULTS
  Group D (n = 20): 4 SD (20%), 4 VE, 12 CS; group H (n = 22): 9 SD (41%), 9 VE, 4 CS; group U (n20): 16 SD (80%), 4 VE. The risk of not having a SD in group D versus U is quadrupled (RR 4; 95% CI 1.6-9.9).
  
  
  CONCLUSIONS
  Ultrasound diagnosis of fetal head upward direction is highly predictive of SD in case of PSSL. Further studies are needed to assess this hypothesis.
authors.affiliation: Department of Surgical Sciences, Maternal-Fetal Medicine Unit, Sant'Anna Hospital, University of Turin , Turin , Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Masturzo
authors.forename: Daniele
authors.initials: D
authors.lastname: De Ruvo
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*
keywords: Hand and knee position; oxytocin; spontaneous delivery; transperineal ultrasound