Prediction of delivery mode by ultrasound‐assessed fetal position in nulliparous women with prolonged first stage of labor

Eggebø, Torbjørn Moe; Hassan, Wassim A.; Salvesen, Kjell Å.; Torkildsen, E.; Østborg, Tilde Broch; Lees, C.

doi:10.1002/uog.14773

Cited by 49 publications

(25 citation statements)

References 43 publications

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“…A more exact diagnosis of position by ultrasound may not be an advantage in low‐risk pregnancies . Yet another recently published study showed that ultrasound assessment of position in nulliparous women with a prolonged first stage of labor can be helpful for clinicians, and be of benefit when determining occipital position in labor is difficult .…”

Section: Discussionmentioning

confidence: 99%

Transperineal ultrasonography for labor management: accuracy and reliability

Kalafat

Koç

2015

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 99%

Transperineal ultrasonography for labor management: accuracy and reliability

Kalafat

Koç

2015

Acta Obstet Gynecol Scand

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“…However fewer than 10% of babies in the study were born by CS, which contrasts markedly with the current Australian experience as reported in maternity clinical indicator data [5]. [89], and in women with a lower BMI [13,90,[92][93][94], and less likely to be successful where baby has a birthweight >4000g (aOR 2.38, 95% CI 1.56-3.70) [13,93] or is in a persistent occipito-posterior position (OR 2.9, 95% CI 1.3-6.7) [87,95,96]. There are also studies reporting an association between IOL performed for some specific indications (hypertension, diabetes [97], post-dates [98]) and the outcome of CS birth.…”

Section: Inpatient Versus Outpatient Pge2 Vaginal Gel Protocolscontrasting

confidence: 51%

Induction of labour using prostaglandin (PGE2) vaginal gel

Beckmann¹

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In Australia each year, more than one in four pregnant women will undergo an induction of labour (IOL). PGE2 vaginal gel is the most commonly used IOL method in Australia and is an effective cervical priming agent, although there are no evidence-based recommendations regarding the optimal dosage and frequency of PGE2 vaginal gel that will deliver the safest, most effective, least costly and more positive healthcare experiences for women.The aim of this thesis was to compare two policies of PGE2 vaginal gel for induction of labour at term: a policy of amniotomy once technically possible (regardless of modified Bishop's score (MBS)), versus a policy of giving more PGE2 vaginal gel (repeat administration and amniotomy only when MBS ≥ 7). Four key objectives were addressed across the domains of clinical outcomes, healthcare experience and healthcare costs. A randomised controlled trial was undertaken to determine which policy of PGE2 vaginal gel IOL results in the shorter IOL-to-birth time and is associated with lower rates of obstetric intervention and morbidity. The data from this trial were then used to develop predictive models to help identify those women who might specifically benefit from one policy versus the other. A healthcare experience tool was developed de novo, validated, and the experiences of women who were induced according to a policy of early amniotomy and repeat PGE2, were compared. And finally, the healthcare costs of women in the two arms of the trial were analysed. A decision-analytic model, specifically a Markov chain, was developed to further investigate costs, and a Monte Carlo simulation was performed to confirm the robustness of these findings.This thesis finds that in women being induced with PGE2 vaginal gel, performing an amniotomy (even if the cervix is deemed unfavourable) is likely to result in similar clinical outcomes, but a shorter labour, a more positive healthcare experience, and lower healthcare costs, when compared to giving more PGE2.

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“…Certainly without large prospective studies on the subject, the evidence for routine use of transperineal ultrasound remains under scrutiny 46 . As prediction models based on intrapartum ultrasound parameters are developed, 44 , 45 , 47 real‐time assessment of labour progress is likely to enhance the objectivity of recording the progress of labour, making it a future tool in active labour 48 . This technology in both the developed and developing worlds could provide information that would allow better planning both for place and mode of delivery thus improving both safety and choice for women.…”

Section: Resultsmentioning

confidence: 99%