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.

Abstract

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.

Citation

Ramphul, M., Ooi, P. V., Burke, G., Kennelly, M. M., Said, S. A., Montgomery, A. A., & Murphy, D. 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), https://doi.org/10.1111/1471-0528.12810

• Journal Article Type: Article
• Acceptance Date: Feb 26, 2014
• Online Publication Date: Apr 10, 2014
• Publication Date: Jun 24, 2014
• Deposit Date: Nov 23, 2017
• Publicly Available Date: Nov 23, 2017
• Journal: BJOG: An International Journal of Obstetrics and Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Not Peer Reviewed
• Volume: 121
• Issue: 8
• DOI: https://doi.org/10.1111/1471-0528.12810
• Keywords: fetal head position; second stage of labour; intrapartum ultrasound, randomised controlled trial
• Public URL: https://nottingham-repository.worktribe.com/output/730159
• Additional Information: This is the pre-peer reviewed version of the following article: Ramphul M, Ooi PV, Burke G, Kennelly MM, Said SAT, Montgomery AA, Murphy DJ. Instrumental delivery and ultrasound (IDUS): 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 2014;121:1029–1038, which has been published in final form at 10.1111/1471-0528.12810. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Nov 23, 2017