Ultrasound and childbirth

The overall aim of this thesis was to undertake a series of studies to investigate different potential applications of ultrasound in relation to various childbirth outcomes in high a middle-income healthcare settings. We are one of the first groups to explore the impact of levator ani muscle coactivation on labour outcomes. We also generated pilot data demonstrating the potential positive impact of biofeedback in overcoming this problem. We were also able to demonstrate the feasibility and validity of an ultrasound scan-based model for the prediction of failure of IOL defined as inability to achieve a vaginal birth and the need for CD.

In our intrapartum work, we focussed on assessing the accuracy and reproducibility of several isolated ultrasound scan parameters in determining the basic obstetric clinical assessments, namely head position and station. This work was extended further to develop and refine a trans-abdominal ultrasound measure for the extent of head descent as the SDA. In addition to generating data confirming its inter-rater reliability, we also demonstrated the strong correlation between this measurement and the previously established AoP.

In our third group of studies, we explored the use of ultrasound scan in the postnatal period either to assess the impact of childbirth on the pelvic floor or the type of caesarean delivery on scar outcome and its potential impact on risk of morbidly adherent placenta in future pregnancies. Last but not least, we presented the effectiveness of blended learning training courses in transperineal ultrasound on candidates’ skill and understanding.