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. (11th April 2014)

• Record Type: Journal Article
• Authors: Ramphul, M; Ooi, PV; Burke, G; Kennelly, MM; Said, SAT; Montgomery, AA; Murphy, DJ
• Is Part Of: BJOG. Volume 121:Number 8(2014:Aug.)
• Page Start: 1029
• Page End: 1038
• Publication Date: 2014-04-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12810
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12810-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12810-sec-0001" sec-type="section"> <title>Objective</title> <p>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.</p> </sec> <sec id="bjo12810-sec-0002" sec-type="section"> <title>Design</title> <p>Two‐arm, parallel, randomised trial, conducted from June 2011 to December 2012.</p> </sec> <sec id="bjo12810-sec-0003" sec-type="section"> <title>Setting</title> <p>Two maternity hospitals in the Republic of Ireland.</p> </sec> <sec id="bjo12810-sec-0004" sec-type="section"> <title>Sample</title> <p>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.</p> </sec> <sec id="bjo12810-sec-0005" sec-type="section"> <title>Methods</title> <p>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.]</p> </sec> <sec id="bjo12810-sec-0006" sec-type="section"> <title>Main outcome measure</title> <p>Incorrect diagnosis of the fetal head position.</p> </sec> <sec id="bjo12810-sec-0007" sec-type="section"> <title>Results</title> <p>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; <italic>P</italic> < 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, <italic>P</italic> = 0.35). The incidence of maternal and neonatal complications, failed instrumental delivery, and caesarean section was not significantly different between the two groups.</p> </sec> <sec id="bjo12810-sec-0008" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>