Introduction

As I approach the conclusion of my residency in Obstetrics and Gynecology (OBGYN), I reflect on the profound impact of Intrapartum Ultrasound (IPUS) on my clinical skills. While the widespread use of IPUS hasn’t been definitively shown to improve perinatal outcomes [1,2], its promise in enhancing clinical skills and confidence is undeniable.

Navigating the uncertainty of manual vaginal examinations

Manual vaginal examinations have long been a cornerstone of obstetric practice, yet their imprecision is widely acknowledged [1-3]. During my residency, I grappled with the subjective nature of these examinations, seeking validation from multiple attending physicians and midwives, each with their own interpretation. The introduction of IPUS provided a sense of clarity and certainty that was previously elusive, offering a solid truth to refer to amidst the variability of manual examinations.

Refining vacuum extraction techniques

Performing vacuum extraction is both an art and a science. While objective parameters can describe the procedure and its outcomes, there exists a dimension that is inherently subjective-the feel of the performer. With Intrapartum Ultrasound (IPUS), I’ve experienced a profound shift in my approach to vacuum extraction. Knowing the exact fetal station, position, and attitude, I’ve felt a significant improvement in my ability to navigate force-vector dynamics, fine-tuning the procedure. Even when objective measurements may not capture the full extent of improvement, I know it is there.

Embracing the promise of intrapartum ultrasound

Despite the lack of definitive evidence demonstrating its impact on perinatal outcomes, I wholeheartedly advocate for the use of IPUS in obstetric practice. As we strive for evidence-based medicine and find a methodological approach to quantify the benefits that many of us intuitively feel, I believe in embracing technology that will enhance our clinical skills and ultimately improve patient care.

Conclusion

As I prepare to embark on the next chapter of my career, I am grateful for the introduction of IPUS during my residency. Its influence on my clinical practice has been profound, providing a sense of confidence and precision that was previously unattainable. While the debate over its impact on perinatal outcomes continues, I remain steadfast in my belief that embracing technology like IPUS is essential for advancing the field of obstetrics and ensuring the best possible outcomes for mothers and babies.

References

1. Ghi T, Eggebø T, Lees C, et al. ISUOG Practice Guidelines: Intrapartum ultrasound. Ultrasound in Obstet & Gyne. 2018; 52(1): 128-139. doi:10.1002/uog.19072
2. Mappa I, Tartaglia S, Maqina P, et al. Ultrasound vs routine care before instrumental vaginal delivery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021; 100(11): 1941-1948. doi:10.1111/aogs.14236
3. Dupuis O, Ruimark S, Corinne D, Simone T, André D, et al. Fetal head position during the second stage of labor: Comparison of digital vaginal examination and transabdominal ultrasonographic examination. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2005; 123(2): 193-197. doi:10.1016/j.ejogrb.2005.04.009
4. Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound in Obstet & Gyne. 2003; 21(5): 437-440. doi:10.1002/uog.103
5. Buchmann E, Libhaber E. Interobserver agreement in intrapartum estimation of fetal head station. Intl J Gynecology & Obste. 2008; 101(3): 285-289. doi:10.1016/j.ijgo.2007.11.020.