Clinical trial NCT01991665: R. I. S. POS. T. A
Official title: Randomised Italian Sonography for Occiput POSition Trial Ante Vacuum
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Vacuum Extraction; Failure, Affecting Fetus or Newborn
Persistent Occiput Posterior Position During Labor
Complication of Delivery
Keywords: Intrapartum Ultrasound
Vacuum
Occiput position
Lead sponsor: University of Bologna
Sponsor class: OTHER
First posted: 2013-11-25
Enrollment: 1400
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: DIAGNOSTIC

Brief summary: A failed operative vaginal delivery is associated with increased risk of maternal and perinatal complications. It is very important the determination of the fetal head position prior to instrumental delivery.

Generally,diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. There is a paucity of studies on the accuracy of digital examination but the general consensus is that reproducibility is low and diagnostic uncertainty remains high even for operators with much experience.

As the traditional clinical evaluation has many limitations, a new tool capable of increasing diagnostic objectivity and accuracy would be of great interest.

The aim of our study was to evaluate, in a prospective study, if the complementary use of ultrasound scan, to diagnose the fetal head position prior to instrumental delivery, may play a role in labor outcome.


Eligibility criteria: Inclusion Criteria:

* women with singleton cephalic pregnancies at term (≥37 weeks' gestation), who require an instrumental delivery

Exclusion Criteria:

* under 18 years of age
* women with contraindications for vacuum delivery
* women with sonography evaluation of fetal head position before randomization
* fetal head station \> +3
* discretion of the responsible obstetrician in cases where there is urgency due to suspected fetal compromise("fetal distress")

Primary outcomes:
measure: failure rate of vacuum extraction in each of the two groups of patients included in the study (number of cesarean deliveries).
timeFrame: 2 years
Secondary outcomes:
measure: Incidence of: neonatal trauma (cephalhaematoma, retinal haemorrhage, facial nerve palsy, brachial plexus injury and fractures), low Apgar scores, fetal acidosis or admission to the neonatal unit, shoulder dystocia
timeFrame: 2 years
measure: Incidence of: primary postpartum haemorrhage, third and fourth degree perineal tears
timeFrame: 2 years
Other outcomes:
Locations:
city: Bologna
country: Italy
facility: Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna
state: Emilia-Romagna
Study officials:
affiliation: Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital
name: Tullio Ghi
role: PRINCIPAL_INVESTIGATOR
References:
citation: Groutz A, Hasson J, Wengier A, Gold R, Skornick-Rapaport A, Lessing JB, Gordon D. Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol. 2011 Apr;204(4):347.e1-4. doi: 10.1016/j.ajog.2010.11.019. Epub 2010 Dec 22.
citation: Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999 Dec 2;341(23):1709-14. doi: 10.1056/NEJM199912023412301.
citation: Dupuis O, Silveira R, Zentner A, Dittmar A, Gaucherand P, Cucherat M, Redarce T, Rudigoz RC. Birth simulator: reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification. Am J Obstet Gynecol. 2005 Mar;192(3):868-74. doi: 10.1016/j.ajog.2004.09.028.
citation: Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol. 2003 May;21(5):437-40. doi: 10.1002/uog.103.
citation: Ramphul M, Kennelly M, Murphy DJ. Establishing the accuracy and acceptability of abdominal ultrasound to define the foetal head position in the second stage of labour: a validation study. Eur J Obstet Gynecol Reprod Biol. 2012 Sep;164(1):35-9. doi: 10.1016/j.ejogrb.2012.06.001. Epub 2012 Jul 2.
citation: Rozenberg P, Porcher R, Salomon LJ, Boirot F, Morin C, Ville Y. Comparison of the learning curves of digital examination and transabdominal sonography for the determination of fetal head position during labor. Ultrasound Obstet Gynecol. 2008 Mar;31(3):332-7. doi: 10.1002/uog.5267.
citation: Zahalka N, Sadan O, Malinger G, Liberati M, Boaz M, Glezerman M, Rotmensch S. Comparison of transvaginal sonography with digital examination and transabdominal sonography for the determination of fetal head position in the second stage of labor. Am J Obstet Gynecol. 2005 Aug;193(2):381-6. doi: 10.1016/j.ajog.2004.12.011.
citation: Wong GY, Mok YM, Wong SF. Transabdominal ultrasound assessment of the fetal head and the accuracy of vacuum cup application. Int J Gynaecol Obstet. 2007 Aug;98(2):120-3. doi: 10.1016/j.ijgo.2007.05.021. Epub 2007 Jun 22.