How to perform fetal ultrasound in labor: assessment of fetal occiput position

Intrapartum assessment of fetal occiput position is of major relevance in the management of the second stage of labor. Indeed, fetal head malposition is associated with higher risk of operative delivery and maternal and perinatal morbidity. Although sonographic assessment of fetal occiput position alone may not predict the mode of delivery accurately, it may be of great value in certain clinical situations, such as before instrumental delivery. Incorrect determination of fetal head position may lead to inappropriate vacuum or forceps blade placement, increasing the risk of both fetal injury and failure of the procedure.

Various studies have demonstrated the higher accuracy and reproducibility of ultrasonographic determination of fetal occiput position as compared with traditional digital examination. Many approaches have been suggested to determine fetal occiput position with ultrasound: transperineal, transvaginal and transabdominal ones. Although the best approach is still unknown, the transabdominal one is the most widely used and practical approach. The aim of this 'How To' article, and accompanying figures, slides and videoclips, is to provide a simple and practical guide to determining accurately and rapidly the fetal occiput position when this information is judged to be clinically relevant.

Read the full article and download the slide presentation of step-by-step guidance below