Artigos sobre Ultrasonografia Intraparto
Atualizado: Fev 17
Quando se pesquisa no pubmed “intrapartum ultrasound” o primeiro artigo é datado de 1967 o que sugere o diagnóstico de um caso de gêmeos conjugados
Link do artigo não disponível na integra: https://journals.lww.com/greenjournal/Citation/1967/01000/Intrapartum_Diagnosis_of_Conjoined_Twins__Report.10.aspx
O segundo artigo não está disponível
. 1970 Nov;41(11):1181-7.
[Intrapartum recognition of fetal distress] [Article in Polish]Z Kornacki
. 1971 Dec;54(12):991-3.
Intrapartum mediastinal and subcutaneous emphysema. A primigravida with pre-eclampsia
Curr Probl Pediatr
. 1972 Jul;2(9):1-29. doi: 10.1016/s0045-9380(72)80018-5.
Current concepts in antepartum and intrapartum fetal evaluation
Este artigo descreve que a ultrassonografia pode ajuda na estimeativa do tamanho da cabeça do bebê e na possibilidade de restrição do crescimento intrauterino e que isso pode ser interessante intraparto.
Mas o termo mesmo “intrapartum ultrasound” é descrito a partir de 1985 no seguinte trabalho:
Intrapartum ultrasound diagnosis of nuchal cord as a decisive factor in management
É relatado o caso de uma paciente que apresentou trabalho de parto com traçado da frequência cardíaca fetal que apresentava desacelerações variáveis repetitivas. O lapso de tempo entre a apresentação e o parto foi minimizado pela confirmação de ultrassom de uma circular de cordão cervical. O parto por cesariana foi realizado, em vez de novas tentativas de reposicionamento materno.
Ultrasound Obstet Gynecol
. 2000 May;15(5):413-7. doi: 10.1046/j.1469-0705.2000.00113.x.
Color ultrasonography: a useful technique in the identification of nuchal cord during labor
Objective: To compare the accuracy of intrapartum ultrasound with and without color Doppler for identification of nuchal cord displacement during labor.
Methods: 180 normal pregnant women, admitted in labor, or for induction to labor, were examined independently by two researchers, using either conventional real-time gray-scale imaging or color Doppler imaging. A repeat examination was performed by the other researcher using the other ultrasound modality. Nuchal cord displacement was classified as either negative, definite or suspicious. Nuchal cord at birth was classified as either tight or loose.
Results: Sixty-two (34%) cases examined using the two ultrasound imaging modalities presented with nuchal cord at delivery. The sensitivity of color Doppler was 96.8%. The accuracy of color Doppler in detecting nuchal cord during labor was significantly better (P < 0.05) than gray-scale imaging alone. The results of a restricted sequential t-test analysis of 53 un-tied pairs showed an overall preference in favor of color Doppler assessment: statistical significance (P < 0.01) was reached after 41 un-tied pairs.
Conclusions: The tight and loose nuchal cord could not be distinguished by ultrasound. Color Doppler imaging can provide useful additional information to gray-scale imaging in the detection of nuchal cord displacement during labor.
Ultrasound Obstet Gynecol
. 2002 Mar;19(3):258-63. doi: 10.1046/j.1469-0705.2002.00641.x.
Intrapartum fetal head position I: comparison between transvaginal digital examination and transabdominal ultrasound assessment during the active stage of labor
Objective: To test the null hypothesis that no correlation exists between transvaginal digital and the gold standard technique of transabdominal suprapubic ultrasound assessments of fetal head position during labor. A secondary objective was to compare the performance of attending physicians vs. senior residents in depicting fetal head position by transvaginal digital examination in comparison with ultrasound, respectively.
Methods: Consecutive patients in active labor at term with normal singleton cephalic-presenting fetuses were included. All participants had ruptured membranes, cervical dilation > or = 4 cm and fetal head at ischial spine station -2 or lower. Transvaginal sterile digital examinations were performed by either senior residents or attending physicians and followed immediately by transverse suprapubic transabdominal ultrasound assessments. Examiners were blinded to each other’s findings. Power-analyses dictated number of subjects required. Statistical analyses included Chi-square, Cohen’s Kappa test and logistic regression analysis. P < 0.05 was considered statistically significant.
Results: One hundred and two patients were studied (n = 102). In only 24% of patients (n = 24), transvaginal digital examinations were consistent with ultrasound assessments (P = 0.002, 95% confidence interval, 16-33). Logistic regression revealed that cervical effacement (P = 0.03) and ischial spine station (P = 0.01) significantly affected the accuracy of transvaginal digital examination. Parity, gestational age, combined spinal epidural anesthesia, cervical dilation, birth weight and examiner experience did not significantly affect accuracy of the examination. The accuracy of the transvaginal digital exams was increased to 47% (n = 48) (95% confidence interval, 37-57) when fetal head position at transvaginal digital examination was recorded as correct if reported within +/- 45 degrees of the ultrasound assessment. The rate of agreement between the two assessment methods for attending physicians vs. residents was 58% vs. 33%, respectively (P = 0.02) with the +/- 45 degrees analysis.
Conclusions: Using ultrasound assessment as the gold standard, our data demonstrate an overall high rate of error (76%) in transvaginal digital determination of fetal head position during active labor, consistent with the null hypothesis. Attending physicians exhibited an almost two-fold higher success rate in depicting correct fetal head position by physical examination vs. residents in the +/- 45 degrees analysis. Intrapartum ultrasound increases the accuracy of fetal head position assessment during active labor and may serve as an educational tool for physicians in training.