title: The Routine Use of Intrapartum Ultrasound in Clinical Decision-Making during the Second Stage of Labor - Does It Have Any Impact on Delivery Outcomes?
abstract: OBJECTIVE
  The study aimed to assess whether the use of intrapartum transperineal ultrasound (US) can reduce the rate of failed vacuum extraction (VE).
  
  
  METHODS
  This is a retrospective cohort study including all women delivering at term with the diagnosis of protracted second stage of labor. The mode of delivery and rate of failed VE were compared between women who underwent a US examination prior to the decision on obstetrical interventions ("+US" group) and those in whom clinical decisions were based upon digital assessment only ("no-US" group).
  
  
  RESULTS
  The study included 635 women. Among the "no-US" group (536), there were 13 failed VE attempts (3.6%) vs. none in the "+US" group (99, p = 0.1). There was a significant difference between the groups regarding mode of delivery (p = 0.001), with a lower cesarean section (CS) rate (20.2 vs. 27.8%) among the "+US" group. Maternal age, body mass index, nulliparity, gestational age at delivery, and birth weight, as well as neonatal short-term outcome did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  We demonstrate that among women who had the addition of intrapartum US during the second stage of labor there was a trend toward a lower rate of failed VE (although not reaching statistical significance), with a lower rate of CS but not affecting neonatal outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel, Affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Barak
authors.forename: Roni
authors.initials: R
authors.lastname: Levy
authors.forename: Orna
authors.initials: O
authors.lastname: Flidel
authors.forename: Svetlana
authors.initials: S
authors.lastname: Zaks
authors.forename: Moshe
authors.initials: M
authors.lastname: Gillor
authors.forename: Zion
authors.initials: Z
authors.lastname: Hagay
authors.forename: Edi
authors.initials: E
authors.lastname: Vaisbuch
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007748:Labor Stage, Second / Q000523:psychology*; D008423:Maternal Age; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data
keywords: Cephalopelvic disproportion; Failed vacuum extraction; Fetal head station/position; Instrumental delivery; Prolonged second stage; Transperineal ultrasound