Impact of additional theoretical training program in the diagnosis of the fetal head position during labor: a prospective observational study.

BACKGROUND: The accuracy of transvaginal digital examination in determining foetal head position is not high enough. This study aimed to evaluate whether an additional training on our new theory could improve the diagnostic accuracy of the foetal head position. METHODS: This was a prospective study conducted at a 3a grade hospital. The study included 2 residents in their first year of training in obstetrics without prior experience in transvaginal digital examination. In the observational study, 600 pregnant women without contraindications to vaginal delivery were included. Two residents were simultaneously trained in the theory of traditional vaginal examination, but resident B received an additional theoretical training program. The pregnant women were randomly assigned to have the foetal head position examined by resident A and resident B. The foetal head position was then confirmed by ultrasound, which was performed by the main investigator. After 300 examinations were independently performed by each resident, the accuracy of foetal head position and perinatal outcomes were compared between the two groups. RESULTS: During the 3-month period, 300 post training transvaginal digital examinations were performed by each resident in our hospital. The two groups were found to be homogeneous for age at delivery, BMI before delivery, parity, gestational weeks at delivery, the rate of epidural analgesia, foetal head position, presence of caput succedaneum, presence of moulding and foetal head station(p > 0.05). The diagnostic accuracy of head position by digital examination was higher for resident B, who was subjected to an additional theoretical training program, than for resident A (75.00% vs. 60.67%, p < 0.001). There were no significant differences in maternal and neonatal outcomes between the two groups (p > 0.05). CONCLUSION: An additional theoretical training program for residents increased the accuracy of vaginal assessment of foetal head position. TRIAL REGISTRATION: Registered at Chinese Clinical Trial Registry Platform (ChiCTR2200064783), October 17, 2022. https://www.chictr.org.cn/edit.aspx?pid=182857&htm=4.

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa.

BACKGROUND: Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa. PURPOSE: To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal-fetal outcomes in women with complete placenta previa. STUDY TYPE: Retrospective. POPULATION: A total of 141 pregnant women (median age, 32; age range, 24-40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition. FIELD STRENGTH/SEQUENCE: A 3 T with T1 -weighted imaging (T1 WI), T2 -weighted imaging (T2 WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence. ASSESSMENT: The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal-fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups. STATISTICAL TESTS: The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference. RESULTS: The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941. DATA CONCLUSION: Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal-fetal perinatal outcomes in patients with complete placenta previa. TECHNICAL EFFICACY STAGE: 2.