Digital vaginal examination has been used to determine the possibility of vaginal delivery because many women find vaginal birth difficult. The use of transperineal ultrasonography, which allows direct visualisation of the fetal skull, to forecast the direction of labor has recently become popular. Ultrasound can assist obstetricians in advising patients and predicting the mode and outcome of labor. The aim of work to determine the role of transperineal ultrasonography in measuring the fetal head perineum distance as a predictor of labor course and outcome, with the objective of lowering complications for both the mother and the newborn as a result of prolonged labor. A total of 100 primigravida women in the active phase of labor were admitted to the labor unit at AL-Zahraa University Hospital and Al- Shatby University Hospital for this study. Vaginal delivery was achieved in 100 percent of the cases studied when the HPD was less than 40 mm. When the distance was between 40 and 50 mm, 89 percent of women had a vaginal birth, whereas 51.9 percent had a vaginal delivery when the distance was more than 50 mm. In monitoring labor progress, intrapartum transperineal ultrasonography evaluation of head perineum distance is accurate. It's simple and quick to measure, with the added benefit of data storage.