Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in the second stage of labor

Instrumental delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

“…[20][21][22][23][24][25][26][27][28][29] Most studies have compared ultrasound assessment and clinical examination earlier in labour rather than immediately before instrumental delivery. There may be less care taken with clinical examination earlier in labour, given that an accurate diagnosis is less critical to safety, unlike the case with instrumental delivery.…”

“…[21][22][23][24][25][26][27][28][29][30] With 80% power and 5% two-sided alpha, a total sample size of 450 for analysis was required. We inflated the target sample to 500 to allow for up to 10% non-collection of primary outcome data, for example in spontaneous vaginal deliveries after randomisation but before diagnosis.…”

“…[13][14][15][16][17][18][19] The fetal head position is diagnosed on vaginal examination by delineating the suture lines of the fetal skull and fontanelles; however, accurate clinical diagnosis can be unreliable, varying between 20 and 75%. [20][21][22][23][24][25][26][27][28][29] The use of abdominal ultrasound to enhance the diagnosis of the fetal head position has been described in a number of small studies, but only two have evaluated the role of ultrasound at instrumental delivery. 21,26,27,[29][30][31] We aimed to compare ultrasound assessment of the fetal head position prior to instrumental delivery with standard care to determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position.…”

“…[20][21][22][23][24][25][26][27][28][29] The use of abdominal ultrasound to enhance the diagnosis of the fetal head position has been described in a number of small studies, but only two have evaluated the role of ultrasound at instrumental delivery. 21,26,27,[29][30][31] We aimed to compare ultrasound assessment of the fetal head position prior to instrumental delivery with standard care to determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position. We postulated that a routine ultrasound scan in addition to clinical examination would reduce the incidence of incorrect diagnosis of the fetal head position, and delivery-related maternal and neonatal morbidity.…”

Moyens de réduire la fréquence et les complications des variétés de position occipitopostérieures lors de l'accouchement

“…Il nous semble que ce type d'erreur serait moins fréquent si, comme nous l'enseignons dans nos écoles de sages-femmes, on prenait soin de déterminer le côté du dos foetal lors de l'admission par la manoeuvre de Budin. En outre, au cours de la phase d'expulsion avec une tête foetale engagée, même l'échographie transabdominale peut être prise en défaut, nécessitant alors l'utilisation d'une sonde vaginale [4].…”