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Sonographic knowledge of occiput position to decrease failed operative vaginal delivery: a systematic review and

Federica Bellussi1, Daniele Di Mascio2, Ginevra Salsi3

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA.

American Journal of Obstetrics and Gynecology
|September 7, 2021
PubMed
Summary

Sonographic assessment of fetal occiput position before operative vaginal delivery did not reduce failed deliveries. However, ultrasound improved diagnostic accuracy compared to clinical assessment, suggesting potential for future improvements in operative vaginal delivery techniques.

Keywords:
delivery outcomeinstrumental vaginal deliveryocciput positionultrasound in labor

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Area of Science:

  • Obstetrics and Gynecology
  • Diagnostic Imaging
  • Clinical Trials

Background:

  • Operative vaginal delivery is a common obstetric procedure.
  • Accurate assessment of fetal occiput position is crucial for successful operative vaginal delivery.
  • Clinical digital assessment of fetal occiput position can be inaccurate.

Purpose of the Study:

  • To evaluate the efficacy of sonographic assessment of fetal occiput position before operative vaginal delivery.
  • To determine if ultrasound can decrease the rate of failed operative vaginal deliveries.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Searched multiple electronic databases up to April 2021.
  • Included RCTs comparing sonographic versus clinical digital diagnosis of fetal occiput position before operative vaginal delivery.

Main Results:

  • Four RCTs with 1007 women were included.
  • No significant difference in failed operative vaginal delivery rates between sonographic and clinical groups (9.9% vs 8.2%).
  • Sonographic diagnosis significantly reduced occiput position discordance compared to clinical assessment (2.3% vs 17.7%).

Conclusions:

  • Sonographic assessment of fetal occiput position does not currently reduce failed operative vaginal deliveries.
  • Ultrasound offers superior accuracy in diagnosing fetal occiput position compared to clinical methods.
  • Future research should explore how improved sonographic accuracy can enhance operative vaginal delivery safety and effectiveness.