Academic Department of Obstetrics & Gynaecology, Trinity College Dublin & Coombe Women & Infant's University Hospital, Dublin 8, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):181-8. doi: 10.1016/j.ejogrb.2012.07.029. Epub 2012 Aug 23.
To establish the current practice of obstetricians with regard to assessment of women in labour before instrumental delivery.
A national postal survey of obstetricians in consultant-led obstetric units in the United Kingdom and Ireland. Clinical assessment before instrumental delivery, factors associated with difficulty in determining the fetal head position, approaches used to enhance determination of the fetal head position, perceived accuracy rates in assessment of the fetal head position and willingness to participate in a clinical trial of ultrasound assessment of the fetal head position before instrumental delivery were explored.
The response rate was 75%. The majority of obstetricians assess women clinically before instrumental delivery as recommended by guidelines. Both consultants and trainees reported the following factors as being associated with difficulty in diagnosing the fetal head position: inadequate maternal pain relief, fetal caput and clinical inexperience. Strategies used when experiencing difficulty in determining the fetal head position varied, with trainees more likely than consultants to seek a second opinion (40% vs. 5%, p<0.0001), reassess in an operating theatre (80% vs. 68%, p=0.048) or abandon the procedure in favour of caesarean section (14% vs. 6%, p=0.035). One in five obstetricians reported using abdominal ultrasound to aid diagnosis, with some consultants reporting the use of ultrasound as 'a great idea' and others being 'appalled'. One in eight consultants perceived that they made an incorrect diagnosis of the fetal head position at instrumental delivery in more than 10% of deliveries compared to one in four trainees.
The contrasting views on the role of ultrasound to enhance the assessment of the fetal head position before instrumental delivery suggest that it should be evaluated in a randomised clinical trial.
评估产科医生在器械分娩前评估产妇的实践情况。
对英国和爱尔兰顾问主导的产科单位的产科医生进行全国性的邮政调查。在器械分娩前的临床评估、与确定胎头位置困难相关的因素、用于增强胎头位置确定的方法、对胎头位置评估的感知准确性率以及参与器械分娩前超声评估胎头位置的临床试验的意愿进行了探讨。
回复率为 75%。大多数产科医生按照指南建议对器械分娩前的妇女进行临床评估。顾问和受训者都报告以下因素与诊断胎头位置困难有关：产妇疼痛缓解不足、胎头肿块和临床经验不足。当确定胎头位置有困难时，使用的策略各不相同，受训者比顾问更有可能寻求第二意见（40%比 5%，p<0.0001）、在手术室重新评估（80%比 68%，p=0.048）或放弃手术改为剖宫产（14%比 6%，p=0.035）。五分之一的产科医生报告使用腹部超声来辅助诊断，一些顾问报告使用超声是“一个好主意”，而另一些则是“震惊”。每 8 名顾问中就有 1 人认为，与每 4 名受训者中就有 1 人相比，他们在 10%以上的分娩中对胎头位置的诊断不正确。
对于超声在器械分娩前增强胎头位置评估的作用的观点截然不同，这表明应该在随机临床试验中进行评估。
