Edorium Journal of

Gynecology and Obstetrics

 
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Original Article
 
Reliability of digital vaginal examination for fetal head position determination: A prospective observational study
Zara L.Z. Lok1, Michael C.M. Chor1
1Resident, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong.
2Associate Consultant, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong.

Article ID: 100002G06ZL2015
doi:10.5348/G06-2015-2-OA-2

Address correspondence to:
Dr. Zara Lin-Zau
Lok, Department of Obstetrics and Gynaecology
Prince of Wales Hospital
Hong Kong
Phone: (852) 2632 3190
Fax: (852) 2636 0008

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How to cite this article
Lok ZLZ, Chor MCM. Reliability of digital vaginal examination for fetal head position determination: A prospective observational study. Edorium J Gynecol Obstet 2015;1:5–9.


Abstract
Aims: Intrapartum transabdominal and perineal ultrasound is touted as the gold standard for determination of fetal head position, but intrapartum digital vaginal examination is conventional and frequently used on its own despite its inaccuracies. Hence the reliability of digital vaginal examination will be evaluated against intrapartum ultrasound.
Methods: In a prospective observational study, 50 paired digital vaginal and ultrasound examinations of fetal head position were obtained in a tertiary hospital labor ward. Digital vaginal examination was by the midwives and attending obstetricians who were blinded to the ultrasound findings. A single sonographer performed all transabdominal and perineal ultrasounds for consistency and did not take part in clinical management.
Results: The median maternal age was 31 years (range 18–37 years) with median gestational age of 40 weeks (range 37–41 weeks). 73.5% (n = 25) had spontaneous vaginal delivery. Absolute agreement between ultrasound and digital examination was 54% (n = 27) with Cohen's kappa of 0.073±0.031. Agreement with a 45° allowance was 80% (n = 40) with Cohen's kappa of 0.728±0.073. Digital exam was more likely to be incorrect (p = 0.019) when the fetal head position was occiput posterior (n = 5, 83.3%) or occiput transverse (n = 4, 66.7%).
Conclusion: When compared to intrapartum transabdominal and transperineal ultrasound, digital vaginal examination is unreliable in determining fetal head position, especially when fetal head position is occiput posterior or transverse.

Keywords: Fetal head position, Transperineal, Intrapartum ultrasound, Transabdominal

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Author Contributions:
Zara L.Z. Lok – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Michael C.M. Chor – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Zara L.Z. Lok et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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