title: Objective diagnosis of arrested labor on transperineal ultrasound.
abstract: OBJECTIVE
  Recent developments in transperineal ultrasound imaging of the pelvis have prompted trials to objectively evaluate labor progression for labor management. We evaluated the accuracy of transperineal ultrasound in diagnosing arrest of labor.
  
  
  METHODS
  Transperineal ultrasound and digital pelvic examinations were performed simultaneously in 63 term laboring patients (singleton fetuses in cephalic presentation). We analyzed a total of 216 ultrasound images (Sonography Volume Computer Aided Display Labor [Sono VCAD Labor®] installed in Voluson E8 ultrasound). We examined the correlation between the three ultrasound parameters head direction (HD), progression distance (PD), and progression angle (PA), and digital pelvic examination findings during labor in a transvaginal delivery group and an arrested labor group.
  
  
  RESULTS
  The coefficient of correlations between HD/PD/PA and cervical dilation/fetal station were 0.667/0.657/0.706 and 0.667/0.751/0.803, respectively. The three parameters had strong correlations with digital pelvic examination (P < 0.05). In the 11 cases (17%) of cesarean section due to arrested labor, the position of the fetal head was visually unchanged on sequential ultrasound images. According to receiver operating characteristic curves, the significant cut-offs for HD, PD, and PA for arrested labor were 105° (P = 0.048), 35 mm (P = 0.048), and 120° (P = 0.001), respectively.
  
  
  CONCLUSIONS
  Transperineal ultrasound imaging is helpful for objective evaluation of labor progression and the diagnosis of arrested labor.
authors.affiliation: Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: Department of Obstetrics and Gynecology, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hachisuga
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D011247:Pregnancy; D012372:ROC Curve; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult
keywords: arrested labor; labor progression; sono VCAD labor®; transperineal ultrasound