P18.06: Placenta percreta of the cervix: a case report

Abstract

Objectives: Assessment of the fetal head station is of crucial importance if safe operative vaginal delivery is to be attempted. Intrapartum translabial ultrasonography (ITU) has recently been applied to measure the fetal head descent objectively. However, it has not been widely used because the reference point of ITU is different from that of digital examination. Whereas digital examination takes the ischiatic spine as a reference point, ITU uses the pubic symphysis because the ischiatic spine is unable to be detected with ultrasonography. In order to compare the finding of ITU with digital examination, we examined the relationship of the pubic symphysis and the ischiatic spine with using pelvic CT data. Methods: Three-dimensional reconstructions from computed tomographic (CT) datasets of 37 normal Japanese female pelvises were used to measure the spatial relationship between pubic symphysis and ischiatic spine. Results:The distance between the interspinous line and the lower end of pubic symphysis ranges from 70-86 mm (79.7 ± 4.5 mm, mean ± SD)and varies greatly between individuals. The angle between midplane of pelvis and the lower end of pubic symphysis is 104-117 • (112.3 ± 3.3 • ). The correlation function with body height is 0.34. Conclusions: It was impossible to make the interspinous plane on the screen of ITU, but the midplane of pelvis can be traced on it. Therefore, ITU can provide the objective information for the assessment of the fetal head descent which has been dependent on the subjective observations of the digital examination, and it will contribute to the safe operative vaginal delivery. Royal Prince Alfred Hospital, Camperdown, NSW, AustraliaObjectives: The purpose of this study was to determine the feasibility of a multicentre randomised control trial to investigate if digital rotation of the fetal head from an occiput posterior (OP) position in the 2 nd stage of labour, prior to the commencement of pushing, reduces the risk of a caesarean section. Methods: We conducted a single centre, double blind, randomised control trial pilot study of 27 women between February 2011 and January 2012. Women were consented antenatally or in the latent phase of labour. Once fully dilated a mobile transabdominal ultrasound scan was performed to confirm position of the fetal head. If an OP position was confirmed, women were eligible to participate, and were randomised to a prolonged vaginal examination (control group) or a digital rotation. The position of the fetal head was confirmed post intervention with transabdominal ultrasound imaging. Ongoing management of labour proceeded as per standard practice for both groups. Maternal demographics, obstetric and neonatal data were collected by chart review, and review of the trial data collection forms. Results: More than 900 women were consented to yield 27 women who proceeded to randomisation. This pilot study is not powered to show statistically significant results or trends. There was no significant difference between the two groups for the incidence of caes...