Intrapartum sonography to determine fetal head position

Akmal, Samira; Tsoi, E; Kametas, Nikos A.; Howard, Richard J.; Nicolaides, Kypros H.

doi:10.1080/jmf.12.3.172.177

Cited by 201 publications

(170 citation statements)

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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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

Ramphul

Ooi

Burke

et al. 2014

BJOG

130

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Objective To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at instrumental delivery and subsequent morbidity. Design Two‐arm, parallel, randomised trial, conducted from June 2011 to December 2012. Setting Two maternity hospitals in the Republic of Ireland. Sample A cohort of 514 nulliparous women at term (≥37 weeks of gestation) with singleton cephalic pregnancies, aiming to deliver vaginally, were recruited prior to an induction of labour or in early labour. Methods If instrumental delivery was required, women who had provided written consent were randomised to receive clinical assessment (standard care) or ultrasound scan and clinical assessment (ultrasound). [Correction added on 17 April 2014, after first online publication: Sentence was amended.] Main outcome measure Incorrect diagnosis of the fetal head position. Results The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group (4/257, 1.6%, versus 52/257, 20.2%; odds ratio 0.06; 95% confidence interval 0.02–0.19; P < 0.001). The decision to delivery interval was similar in both groups (ultrasound mean 13.8 minutes, SD 8.7 minutes, versus standard care mean 14.6 minutes, SD 10.1 minutes, P = 0.35). The incidence of maternal and neonatal complications, failed instrumental delivery, and caesarean section was not significantly different between the two groups. Conclusions An ultrasound assessment prior to instrumental delivery reduced the incidence of incorrect diagnosis of the fetal head position without delaying delivery, but did not prevent morbidity. A more integrated clinical skills‐based approach is likely to be required to prevent adverse outcomes at instrumental delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ramphul

Ooi

Burke

et al. 2014

BJOG

130

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“…Several studies recommend verifying the position by ultrasonography to improve the reliability of the diagnosis of the OP position 16, 17…”

Section: Introductionmentioning

confidence: 99%

Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial

Guittier

Othenin‐Girard

Gasquet³

et al. 2016

BJOG

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ObjectiveTo evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position.DesignRandomised controlled trial.SettingGeneva University Hospitals, Switzerland.PopulationA total of 439 women with a fetus in the occiput posterior position during the first stage of labour.MethodsThe women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position.Main outcome measuresThe rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation.ResultsOne hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93–2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02).ConclusionsThis study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level.Tweetable abstractHands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women.

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“…Среди них ос-новным является недостаточная информированность акушеров-гинекологов о повреждающем действии на мозг плода даже умеренной гипоксии в течение беременности. Изучение последствий длительной угрозы прерывания беременности, а возможно и ее медикаментозного сохранения, показало высокий процент гипоксии-ишемии мозга новорожденного, проявляющейся ранними и отдаленными невроло-гическими расстройствами [2,4,[16][17][18]. Кроме это-го, роды при длительном сохранении беременности наступают или раньше положенного гестационного срока, или позже, причем при переношенности -на фоне родостимуляции [2,16].…”

Section: Ch I Ld Neurology R U S S I a N J O U R N A L O Funclassified

Comparative Characteristics of the Neurological Status of Infants Born in the I and Ii Physiological Positions

Морозова¹,

Petrova²,

Хасанов³

2016

Rus. ž. det. nevrol.

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Intrapartum sonography to determine fetal head position

Abstract: Routine digital examination during labor fails to identify the correct fetal position in the majority of cases.

Cited by 201 publications

References 1 publication

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

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

Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial

Comparative Characteristics of the Neurological Status of Infants Born in the I and Ii Physiological Positions

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