Fetal head position during the second stage of labor: Comparison of digital vaginal examination and transabdominal ultrasonographic examination

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.…”

Trials and tribulations of operative vaginal delivery

“…It has been shown by ultrasound techniques that clinical examination fails to diagnose occipitoposterior positions in up to 50% of cases. 16 Consequently, when position is in doubt, it may be helpful to invoke ultrasonography as a method to determine accurately the position of the fetal head prior to instrumental delivery. 17 The RCOG, in a Working Party Report, 18 has acknowledged that the rapid changes occurring in obstetrics and gynaecology with the introduction of a variety of new skills combined with changes in work practices, training conditions and employment law have produced immense pressures on current models of service provision.…”

The Routine Use of Intrapartum Ultrasound in Clinical Decision-Making during the Second Stage of Labor - Does It Have Any Impact on Delivery Outcomes?

“…Misdiagnosis or failure to correctly identify the fetal head position and station is one of the causes of failed instrumental delivery and subsequently of higher rate of neonatal morbidity [11][12][13] . In recent years, intrapartum ultrasound (US) has been suggested as a more objective and reliable tool than digital vaginal examination for assessing fetal head position and station as well as in predicting the success of labor [14][15][16][17][18][19][20][21][22] . Several methods have been used for that purpose [23][24][25][26][27][28][29][30] including fetal occiput positioning [31] , angle of progression (AOP) [17][18][19], and head direction [9,14] .…”