Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor

Chou, Margaret R.; Kreiser, Doron; Taslimi, M. Mark; Druzin, Maurice L.; El‐Sayed, Yasser Y.

doi:10.1016/j.ajog.2004.01.029

Cited by 116 publications

(74 citation statements)

References 8 publications

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

“…[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.…”

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

125

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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

125

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“…Intrapartum transperineal ultrasonography (ITU) has been suggested as a much more reliable method for assessing fetal head descent, as it provides objective and reproducible results. 8 It is neither time-consuming nor causes discomfort of the patient. 9 However, it may not be available everywhere.…”

mentioning

confidence: 99%

Mueller-Hillis maneuver and angle of progression: Are they correlated?

Mendes

Silva

Martins

et al. 2017

Rev. Assoc. Med. Bras.

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Objective: Mueller-Hillis maneuver (MHM) and angle of progression (AOP) measured by transperineal ultrasound have been used to assess fetal head descent during the second stage of labor. We aimed to assess whether AOP correlates with MHM in the second stage of labor. Method: A prospective observational study including women with singleton pregnancy in the second stage of labor was performed. The AOP was measured immediately after the Mueller-Hillis maneuver. A receiver-operating characteristics (ROC) curve analysis was performed to determine the best discriminatory AOP cut-off for the identification of a positive MHM. A p-value less than 0.05 was considered statistically significant. Results: One hundred and sixty-six (166) women were enrolled in the study and 81.3% (n=135) had a positive MHM. The median AOP was 143° (106° to 210°). The area under the curve for the prediction of a positive maneuver was 0.619 (p=0.040). Derived from the ROC curve, an AOP of 138.5° had the best diagnostic performance for the identification of a positive MHM (specificity of 65% and a sensitivity of 67%). Conclusion: An AOP of 138° seems to be associated with a positive MHM in the second stage of labor.Keywords: second stage of labor, angle of progression, Mueller-Hillis maneuver, intrapartum, ultrasonography.

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“…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] .…”

mentioning

confidence: 99%

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

Barak

Levy²,

Flidel³

et al. 2017

Gynecol Obstet Invest

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Background/Aims: The study aimed to assess whether the use of intrapartum transperineal ultrasound (US) can reduce the rate of failed vacuum extraction (VE). Methods: This is a retrospective cohort study including all women delivering at term with the diagnosis of protracted second stage of labor. The mode of delivery and rate of failed VE were compared between women who underwent a US examination prior to the decision on obstetrical interventions (“+US” group) and those in whom clinical decisions were based upon digital assessment only (“no-US” group). Results: The study included 635 women. Among the “no-US” group (536), there were 13 failed VE attempts (3.6%) vs. none in the “+US” group (99, p = 0.1). There was a significant difference between the groups regarding mode of delivery (p = 0.001), with a lower cesarean section (CS) rate (20.2 vs. 27.8%) among the “+US” group. Maternal age, body mass index, nulliparity, gestational age at delivery, and birth weight, as well as neonatal short-term outcome did not differ significantly between the 2 groups. Conclusions: We demonstrate that among women who had the addition of intrapartum US during the second stage of labor there was a trend toward a lower rate of failed VE (although not reaching statistical significance), with a lower rate of CS but not affecting neonatal outcome.

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Vaginal versus ultrasound examination of fetal occiput position during the second stage of labor

Cited by 116 publications

References 8 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

Mueller-Hillis maneuver and angle of progression: Are they correlated?

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

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