Women’s compliance with ultrasound in labor: a prospective observational study*

Objective: To explore women’s compliance with ultrasound evaluation (UE) during labor compared with standard vaginal examination (VE). Methods: This is a prospective observational cohort study including uncomplicated singleton pregnancies with the fetus in vertex presentation from 37 weeks of gestation. Labor progress was assessed by both VE and UE. Women acceptability was assessed using a modified Wijma Delivery experience questionnaire (W-DEQ) based on six different items and resulting in a score ranging from 6 (not tolerated) to 36 (well tolerated). The primary outcome of the study was to compute the differences in the overall modified W-DEQ questionnaire between UE and VE. Secondary outcomes were to assess the differences between UE and VE in each individual item of modified W-DEQ questionnaire and to elucidate whether such differences persist in pregnancies experiencing compared to those not experiencing prolonged labor or unplanned emergency operative delivery. Results: One hundred and twenty-four women were included in the study and 109 completed the full questionnaire. The overall global acceptability score was significantly higher for UE compared to VE (27 IQR 25–29 versus 18 IQR 16–22; p ≤.001). When stratifying the analysis to each individual item of the W-DEQ questionnaire separately, significant differences for intrusiveness (p =.04); painful (p =.01) and privacy ensured (p =.01) were found between UE and VE. In pregnancies experiencing prolonged labor, the global W-DEQ acceptability score for UE resulted significantly higher (30 versus 23; p =.005) than in those delivering within 12 hours. Likewise, UE acceptability score was significantly higher (28 IQR 24–30 versus 22 IQR 20–25; p =.01) in women having spontaneous vaginal birth compared to those undergoing operative delivery. Finally, there was no difference in the acceptability score between women with spontaneous onset of labor compared to those undergoing elective induction. Conclusions: UE is better tolerated VE for assessment of labor progress; women’s compliance with UE prior to delivery increased in the presence of prolonged labor or unplanned operative delivery.