الفهرس 
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Abstract
SUMMARY
L
abour is commonly divided into three stages. The duration of the first and second stages of labor vary, dependent on parity.
Nulliparous women tend to have a longer labor than multiparous women. Delay can result from poor uterine contractions or the relationship between size, presentation, and position of the fetus and the maternal pelvis that obstructs vaginal delivery. Uterine contractile dysfunction affects between 11% and 30% of nulliparous women.
Prolonged labor is associated with higher rates of chorioamnionitis with risk of neonatal sepsis and of unplanned caesarean section with associated risks of infection and bleeding.
In this study, we aimed to investigate whether transabdominal ultrasound assessment of fetal head position is correlated with rate of Cesarean section in nulliparous women with a prolonged active first stage of labor.
This prospective observational cross-sectional study was conducted at tertiary care hospital at Ain Shams university maternity hospital from January 2023 till October 2023 and performed on a total of 382 nulliparous women with a prolonged first stage of labour at or after 37 weeks’ gestation.
The current study revealed that mean maternal age, BMI, Gestational age and expected fetal weight (kg) was 23.1±4.4, 24.7±3.7, 38.8±1.0 and 3.1±0.3 respectively. Examination of fetal head positions showed that occipito-anterior (OA) was detected in 63.6% of cases, followed by occipito-posterior (OP) (19.9%) and occipito-transverse (OT) (16.5%) with no statistically significant differences according to fetal head position regarding baseline maternal and fetal characteristics.
As regards maternal outcome, our study results revealed that mean time to delivery was 493.7±141.6 minutes. The most frequent mode of delivery was spontaneous vaginal delivery (SVD) (80.4%), followed by CS (17.5%), then Operative Vaginal Delivery (OVD) (2.1%). Postpartum hemorrhage was detected in 4.7% of cases. Consequently, most fetuses in OP positions in the first stage of labor rotated spontaneously and had a high probability of being delivered vaginally.
However, our study demonstrated that time to delivery (minutes) among all cases and among modes of delivery was significantly longest in OP with no significant differences between OA and OT. SVD was significantly least frequent in OP with no significant differences between OA and OT.
Consequently, CS was significantly most frequent in OP with no significant differences between OA and OT. Furthermore, there was no significant difference according to fetal head position regarding OVD and the possibility of postpartum hemorrhage.
As regards fetal outcome, our study results revealed that the mean birth weight (kg) was 3.0±0.8. The median APGAR-1 and APGAR-5 was 7.0 (7.0−8.0) and 9.0 (8.0−9.0) respectively with no statistically significant differences according to fetal head position regarding neonatal outcome.
Ultimately, our study results reported that OP fetal head position had Low sensitivity (44.8%), moderate Specificity (85.4%) and Negative predictive value (87.9%), but low other predictive characteristics in predicting cesarean section delivery.
We concluded that most fetuses in OP positions in the first stage of labor rotated spontaneously and delivered vaginally. Ultrasonography is an easy method of assessing fetal head position before induction and in the first stage of labor. Ultrasound assessment of occipital position of the fetal head before delivery had low sensitivity and moderate specificity in the prediction of mode of delivery. However, an OP position at this stage may be associated with prolonged labor and it is not associated with an increased risk of cesarean delivery.
We recommend that sonographic assessment of occipital position of the fetal head before delivery should not be used in the prediction of mode of delivery. However, it can be used for counselling the patients for prolonged first stage of labor.
LIMITATIONS
T
he limitations of the study are worthy of mention including that only one ultrasound examination was performed in each woman, and the precise position of the fetal head immediately before intervention was not known. This explains why position at delivery in some cases differed from the ultrasound-assessed position. Another limitation is that the study was conducted at single center with a limited target population and, hence, lack representation of the wider patient population, reducing their external validity. Multicenter studies allow for comparison of effects between centers, which provide insight into the generalizability of effects across institutions