Transabdominal ultrasound assessment of the fetal head and the accuracy of vacuum cup application

Wong, Grace; Mok, Young-Jae; Wong, Shiu F.

doi:10.1016/j.ijgo.2007.05.021

Cited by 50 publications

(24 citation statements)

References 11 publications

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“…Two small-scale studies had findings similar to ours. 21,31 A cohort study of 64 women reported an incorrect diagnosis rate of 27% for vaginal examination compared with ultrasound, with errors more likely with OP positions. 21 A randomised trial of 50 women undergoing vacuum extraction for prolonged second stage reported that cup placement was closer to the flexion point, and therefore more optimal, in the group assigned to ultrasound compared with vaginal examination only.…”

Section: Discussionmentioning

confidence: 99%

“…21 A randomised trial of 50 women undergoing vacuum extraction for prolonged second stage reported that cup placement was closer to the flexion point, and therefore more optimal, in the group assigned to ultrasound compared with vaginal examination only. 31 The decision to delivery interval is an important consideration for instrumental delivery. 33 It was reassuring that the addition of an ultrasound scan as part of the assessment did not introduce a delay in delivery.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

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: Discussionmentioning

confidence: 99%

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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“…The cap must be placed at or close to the flexion point on the vertex. Ultrasound aided examination has been shown to detect this flexion point better than digital examination alone [Wong, 2007;Molina and Nicholides, 2010] …”

Section: Head Position For Vacuummentioning

confidence: 99%

The Role of Obstetric Ultrasound in Reducing Maternal and Perinatal Mortality

Wiafe¹,

Odoi²,

Dassah³

2011

Ultrasound Imaging - Medical Applications

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“…In this study of vacuum extractions, incorrect cup placement was reported in about half of the procedures and an increase in neonatal injury from 5% for flexing median placement of the cup to 45% for deflexing paramedian application [23] . Wong et al [25] have demonstrated that the accuracy of vacuum cup placement prior to vacuum extraction can be improved using transabdominal ultrasonographic assessment of the fetal head position. They randomly allocated 50 women with prolonged second stage to either digital examination (n = 25) or digital examination together with transabdominal intrapartum ultrasound (n = 25) prior to vacuum extraction by the attending obstetrician.…”

Section: Ultrasound To Define Fetal Head Position Before Instrumentalmentioning

confidence: 99%

Ultrasound in Labor and Delivery

Molina

Nicolaides

2010

Fetal Diagn Ther

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Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for cesarean section. In the management of labor there is extensive evidence that digital pelvic examination does not provide accurate assessment of the position and descend of the fetal head both during the first but also in the second stage of labor. Several recent studies using both two- and three-dimensional ultrasound have now described objective measures of progression of the fetal head during labor. In instrumental deliveries an important determinant of a successful and safe use of vacuum and forceps is the correct determination of the fetal head position and appropriate application of the instrument. However, ultrasound studies have shown that digital examination before instrumental delivery fails to identify the correct fetal position in a high proportion of cases. The use of ultrasound is of crucial importance in performing a safe operative delivery and can help in the prediction of whether a vaginal delivery would be successful.

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Transabdominal ultrasound assessment of the fetal head and the accuracy of vacuum cup application

Abstract: Intrapartum transabdominal ultrasound assessment of the fetal head position during the second stage of labor improves the accuracy of vacuum cup placement during vacuum extraction for prolonged second stage.

Cited by 50 publications

References 11 publications

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

The Role of Obstetric Ultrasound in Reducing Maternal and Perinatal Mortality

Ultrasound in Labor and Delivery

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