I have won the British Medical Association Helen Lawson Grant 2014 for this work.
Background: Currently, all women admitted to delivery units throughout the world undergo internal digital vaginal examination (digital VE) when they are thought to be in labour or where a diagnosis of labour needs to be discounted. The digital VE is an age-honoured practice however it is an uncomfortable experience for the labouring woman, is a notoriously subjective technique and agreement between observers is frequently poor. Multiple examinations have been linked to infection to the mother or fetus reducing the time to delivery in preterm labour.
It has recently become possible to make assessments more objectively using ultrasound. The favoured technique is transperineal ultrasound, where an ultrasound transducer encased in a clean cover is placed on the mother’s perineum but not in the vagina and assessments of the descent of the presenting part of the baby, its position and cervical dilatation can be made within 1-2 minutes and without exerting undue pressure, These measurements can be saved as ultrasound images and compared or assessed offline.
We, at Imperial College, are carrying out the Sono-VE Study: Assessing the acceptability and feasibility of transperineal ultrasound and developing an ultrasound based predictive model for labour outcome; the sonopartogram. This is a prospective observational study of 700 women using transperineal ultrasound between 24-42 weeks gestation and a prospective longitudinal observational study in all term (37-42 weeks) labouring women.
Future: This will enhance the accurate recording of labour to a recordable skill. Universally, it may reduce intrusive internal examinations and associated infection and will also be potentially useful in allowing the assessment of women in whom digital VE is traumatic or contra-indicated.
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et al., 2023, The sonopartogram., Am J Obstet Gynecol, Vol:228, Pages:S997-S1016
et al., 2022, Novel artificial intelligence approach for automatic differentiation of fetal occiput anterior and non-occiput anterior positions during labor, Ultrasound in Obstetrics & Gynecology, Vol:59, ISSN:0960-7692, Pages:93-99
et al., 2020, Etiology and perinatal outcome in periviable fetal growth restriction associated with structural or genetic anomalies, Ultrasound in Obstetrics and Gynecology, Vol:55, ISSN:0960-7692, Pages:368-374
et al., 2019, Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery, Ultrasound in Obstetrics and Gynecology, Vol:54, ISSN:0960-7692, Pages:524-529
et al., 2019, Prediction of mode of delivery using the first ultrasound-based “intrapartum app”, American Journal of Obstetrics and Gynecology, Vol:221, ISSN:0002-9378, Pages:163-166