| Summary: | Objectives: 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: 514 nulliparous women at term (≥37 weeks' gestation) with singleton cephalic pregnancies, aiming to deliver vaginally were recruited prior to 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 ultrasound assessment (ultrasound).
Main outcome: 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 (CI) 0.02 to 0.19, p value <0.001). The decision to delivery interval was similar in both groups (ultrasound mean 13.8 minutes, SD 8.7, versus standard care mean 14.6 minutes, SD 10.1, p value 0.35). The incidence of maternal and neonatal complications,4 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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