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Intrapartum Fetal Assessment

Poster Session 4

(1147) The use of intrapartum ultrasound in operative vaginal delivery: a cohort study

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Operative vaginal birth (OVB) is associated with higher maternal and perinatal morbidity. A safety bundle, including routine intrapartum ultrasound (IPUS), a structured time-out and procedural checklist, aims to improve accuracy of assessing fetal position, interdisciplinary communication and adherence to guidelines at OVB. We aim to compare deliveries where IPUS was and was not used during the safety bundle implementation period at Monash Health.

Study Design:

We performed a prospective cohort study of OVB and second-stage caesareans with a term singleton cephalic fetus at Monash Health. We compared deliveries when IPUS was and was not used. To control confounding by indication, we estimated propensity scores (PS) for the probability of using IPUS for each case and adjusted the effect estimates for the PS using multivariable logistic regression models. The primary outcome was neonates delivered in an unexpected position. Neonatal and maternal morbidity were also assessed.

Results:

There were 1077 second stage operative births from August 2022 to June 2023, of which IPUS was used in 432, and not used in 645. In deliveries where IPUS was used, there was more often fetal malposition (34% vs 23%, p< 0.001) and mid-cavity station (49% vs. 35%, p< 0.001), and greater use of the time-out (56 vs 37%, p< 0.001) and checklist (77% vs 56%, p< 0.001). IPUS was associated with more forceps (66% vs. 58%, adjusted OR [adjOR] 1.35, 95%CI 1.03-1.77, p = 0.028) and a trend to less vacuum births (25% vs. 33%, adjOR 0.75, 95%CI 0.56-1.00, p = 0.052). IPUS was associated with significantly less infants delivered in an unexpected position (0.2% vs. 2.2%, adjOR 0.09, 95% CI 0.01-0.70, p=0.021) and reduced composite neonatal morbidity including Apgar 5 min < 7, cord lactate >8mmol/L, need for resuscitation, birth trauma or neonatal intensive care unit admission (20.6% vs. 25.3%, adjOR 0.66 [95%CI 0.48-0.91], p = 0.011).

Conclusion:

Use of IPUS as part of an OVB safety bundle was associated with less infants delivered in an unexpected position and reduced neonatal morbidity.