2D-transperineal ultrasound in delivery room: Contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review

Aims

Ultrasound is used in the delivery room to assess fetal head position, engagement during labor, and anal sphincter injuries in the immediate postpartum period. The transperineal approach allows for direct visualization of the structures of interest without altering anatomical landmarks. Various ultrasound measurements during labor have been described in the literature, and their use varies widely across maternity units. Our objective was to conduct a systematic review of the literature on relevant ultrasound parameters for the management of labor and delivery.

Material and methods

We reviewed articles indexed in MEDLINE from 1990 to 2022, selecting those that evaluated transperineal ultrasound during labor for term singleton fetuses in cephalic presentation.

Results

We identified 124 articles out of 394 references, including 4 randomized controlled trials, 108 prospective studies, 6 cross-sectional studies, and 6 retrospective studies. The Angle of Progression (AOP) is better documented and appears more reliable than the Head-Perineum Distance (HPD) for diagnosing engagement, monitoring labor, and predicting its outcome. The HPD is easier to perform but shows inconsistencies in the literature. The Head Progression Distance (HPrD) shows good performance but requires further studies before routine use, as does Head-Symphysis Distance (HSD). Recent studies show a growing interest in ultrasound biofeedback of fetal head progression to improve pushing efforts as well as screening for Obstetrical Anal Sphincter Injuries (OASIS).

Conclusions

Transperineal ultrasound is a minimally invasive technique that can be used routinely in the delivery room. It can aid in monitoring labor, predicting the mode of delivery, and may serve as valuable biofeedback to optimize pushing during expulsion.