Ultrasound in the second stage of labour for fetal position – a randomised controlled trial

INTERVENTION: Digital vaginal examination will be as per current care. The ultrasound will be performed by a senior obstetrician using a hand held transducer on the maternal abdomen to assess fetal head position. The procedure would take no more than a couple of minutes. Adherence will be noted on the study sheet completed for all women having a vacuum birth. CONDITION: suction cup malposition PRIMARY OUTCOME: i) Position of the baby as assessed by the midwife ascribing the vacuum birth ii). Position of the cup placement noted at birth – this will be noted from the instrument markings on the neonatal head by the paediatric Registrar who is always present at these births SECONDARY OUTCOME: Sequential use of instruments ‐ as recorded by the scriber present during the procedure ; caesarean section for failed instrumental delivery ‐ as recorded in teh birth Register i). a composite outcome: ; a. Neonatal trauma (bruising, laceration, cephalohaematoma, su bgaleal haemorrhage, retinal haemorrhage) as assessed by the paediatric Registrar ; b. fetal acidosis (arterial pH below 7.10 and base excess greater than‐12.0 mmol) ; c. admission to the neonatal unit. ii). Maternal: compare the incidence of>3 pulls‐ each pull is recorded by the scriber during the procedure with time of application of each pull as well iii). number of pop offs ‐ as recorded by scriber present during procedure iv). Third and fourth degree perineal tears‐ a mandatory requirement when perineum is examined after procedure on the assisted birth template v). Maternal satisfaction of the instrumental delivery process.‐ assessed using a simple survey form with Likert scale INCLUSION CRITERIA: Gestational age 37 weeks or above, singleton, cephalic presentation and need for instrumental delivery.