The sonographic assessment of labor progress, fetal wellbeing and the pelvic floor in the context of childbirth: developing new applications to improve labor outcome and identify high-risk patients for related morbidities.

For ages, the assessment of labor progress and pelvic floor injury related to childbirth, has been based merely on clinical skills. Over the last decades, it has been well established that a vaginal examination to assess cervical dilatation, fetal position and descent during labor, is not accurate, poorly reproducible and often considered uncomfortable for the patient. Evaluation of pelvic floor damage after childbirth, is based on the same clinical principles of inspection and palpation (vaginal and/or rectal examination). Often, lesions with the most serious implications are either missed (Obstetric Anal Sphincter Injury, OASI) or not evaluated at all (avulsion of the Levator Ani Muscle). Both have the potential to have a significant negative impact on the patients quality of life in later stages, because of their association with fecal incontinence (OASI) and pelvic organ prolapse (Levator Ani Avulsion). There is a growing body of evidence that ultrasound allows for a more objective evaluation of labor progress and the pelvic floor after childbirth, in addition to our current clinical practice. Our project will focus on the development of new strategies for education and implementation of these techniques, in order to identify patients at high risk for a complicated labor/delivery and related morbidities.