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
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 ho...
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| Format: | Article |
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Wiley
2014
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| Online Access: | https://eprints.nottingham.ac.uk/48300/ |
| _version_ | 1848797735123156992 |
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| author | Ramphul, Meenakshi Ooi, Poh Vei Burke, Gerard Kennelly, Mairead M. Said, Soha A.T. Montgomery, Alan A. Murphy, Deidre J. |
| author_facet | Ramphul, Meenakshi Ooi, Poh Vei Burke, Gerard Kennelly, Mairead M. Said, Soha A.T. Montgomery, Alan A. Murphy, Deidre J. |
| author_sort | Ramphul, Meenakshi |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T20:08:36Z |
| format | Article |
| id | nottingham-48300 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:08:36Z |
| publishDate | 2014 |
| publisher | Wiley |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-483002024-08-15T15:15:42Z https://eprints.nottingham.ac.uk/48300/ 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, Meenakshi Ooi, Poh Vei Burke, Gerard Kennelly, Mairead M. Said, Soha A.T. Montgomery, Alan A. Murphy, Deidre J. 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. Wiley 2014-06-24 Article NonPeerReviewed Ramphul, Meenakshi, Ooi, Poh Vei, Burke, Gerard, Kennelly, Mairead M., Said, Soha A.T., Montgomery, Alan A. and Murphy, Deidre J. (2014) 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. BJOG: An International Journal of Obstetrics and Gynaecology, 121 (8). pp. 1029-1038. ISSN 1471-0528 fetal head position; second stage of labour; intrapartum ultrasound randomised controlled trial doi:10.1111/1471-0528.12810 doi:10.1111/1471-0528.12810 |
| spellingShingle | fetal head position; second stage of labour; intrapartum ultrasound randomised controlled trial Ramphul, Meenakshi Ooi, Poh Vei Burke, Gerard Kennelly, Mairead M. Said, Soha A.T. Montgomery, Alan A. Murphy, Deidre J. 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | fetal head position; second stage of labour; intrapartum ultrasound randomised controlled trial |
| url | https://eprints.nottingham.ac.uk/48300/ https://eprints.nottingham.ac.uk/48300/ |