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Sonographische Beurteilung der Einstellung und des Höhenstandes vor vaginal-operativer Entbindung

Sonographic assessment of the positioning and level of head descent before operative vaginal delivery

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Der Gynäkologe Aims and scope

Zusammenfassung

Eine Sonographie wird mittlerweile in vielen Kreißsälen routinemäßig sub partu durchgeführt. Untersuchungen konnten zeigen, dass der transperineale Ultraschall unter Verwendung des Austreibungswinkels zur Beurteilung des Höhenstandes vor vaginal-operativen Entbindungen das Potenzial hat, die Kaiserschnittrate ohne erhöhte maternale und neonatale Morbidität zu reduzieren. Allerdings konnte eine aktuelle Studie aus Irland keinen Einfluss der Anwendung des Ultraschalls zur Bestimmung der Einstellung des fetalen Kopfes auf die Morbidität nachweisen. Bisher gibt es noch keine Studie zur Akzeptanz der Sonographie durch die kreißende Frau, und zwar zur Auswirkung der Sonographie auf den Geburtsverlauf. Allgemein bekannt ist, dass die Sonographie stark untersucherabhängig ist und dass Talent und Erfahrung für das Erstellen und Interpretieren sonographischer Bilder nicht zu unterschätzen sind. In den Händen des erfahrenen Untersuchers ist die Sonographie eine sehr sinnvolle Informationsquelle. Bislang hat nur eine Studie die für das Erreichen relevanter und verlässlicher Information notwendige Erfahrung im transperinealen Ultraschall systematisch analysiert. Weitere Forschung ist notwendig, um zu zeigen, dass die routinemäßige Verwendung des Ultraschalls vor Durchführung einer vaginal-operativen Entbindung eine valide, reproduzierbare und sichere Methode ist, welche die Entscheidung über das weitere Vorgehen bei verlängertem Geburtsverlauf zu erleichtern vermag und die Sicherheit instrumenteller Entbindungen erhöhen kann.

Abstract

Ultrasound scanning is routinely performed intrapartum in many delivery rooms. Investigations have shown that transperineal ultrasound using the angle of progression to quantify fetal head descent before operative vaginal delivery has the potential to reduce the rate of cesarean sections without increasing maternal and neonatal morbidity. However, recently Ramphul et al. could not confirm the influence of the use of ultrasound for assessing the position of the fetal head on morbidity. Currently, no study has yet been carried out to systematically assess the acceptability of ultrasound for women in labor. It is generally agreed that sonography is highly operator-dependent and the skill and experience required to obtain and interpret sonographic images should not be underestimated. In the hand of an experienced operator, ultrasound is a very useful tool; however, only one study has systematically looked at the level of expertise required to obtain reliable information by transperineal ultrasound. Further research is required to demonstrate that routine use of ultrasound prior to performing an operative vaginal delivery is a valid, reproducible, acceptable and safe intervention, which can enhance decision-making about the ongoing management of a prolonged second stage of labor.

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Einhaltung ethischer Richtlinien

Interessenkonflikt: A.M. Dückelmann und K.D. Kalache geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Gynäkologie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    A.M. Dückelmann

  2. Klinik für Geburtsmedizin, Campus Mitte, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    K.D. Kalache

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Correspondence to A.M. Dückelmann.

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Dückelmann, A., Kalache, K. Sonographische Beurteilung der Einstellung und des Höhenstandes vor vaginal-operativer Entbindung. Gynäkologe 47, 871–878 (2014). https://doi.org/10.1007/s00129-014-3468-z

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  • DOI: https://doi.org/10.1007/s00129-014-3468-z

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