Presentation scanning prior to induction of labour, Standing Operating Procedure

Maternity & Gynaecology Guidelines
NHS GGC

Objectives

To provide practical guidance for midwifery staff performing bedside ultrasound to determine fetal presentation in all women presenting for induction of labour.

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Rationale

Undiagnosed breech presentation in labour is associated with fetal morbidity and mortality and significant maternal anxiety. The literature states that 3-4% of pregnant women carry a breech baby to term and 10% of those are not detected until labour1.

Accuracy in correctly identifying fetal presentation (cephalic or “head down”) by means of abdominal palpation is variable. The increase in women with a raised BMI contributes to difficulties with accurate identification of presentation.  With increasing availability of ultrasound machines training midwifery staff in the use of hand held ultrasound scanners may be a valuable complement to abdominal palpation in all women prior to induction of labour2.

Training

For competence to be assessed the midwifery staff member should perform a minimum of 3 consecutive ultrasound scans where presentation (identification of the fetal head) is correctly identified or until individual is deemed competent/confident.

The assessor should be a member of medical staff appropriately with appropriate training in ultrasonography.

A log of those staff members who have achieved competence should be kept and held by the senior charge midwife overseeing the clinical area.

Ongoing competence should be assessed yearly.

Procedure

  • All bedside ultrasounds must be conducted by midwives who have completed the ward ultrasound training programme (as agreed by designated medical/midwifery staff).
  • These ultrasounds are to review fetal PRESENTATION only.
  • Post normal CTG and pre vaginal examination, the midwife will apply ultrasonic gel to the maternal abdomen, superior to maternal pelvis.
  • Using the Butterfly IQ+ ultrasound probe the midwife will scan to identify the fetal presenting part.
  • If the fetal presenting part is the fetal head and cephalic presentation is confirmed the midwife will perform a vaginal examination to enable the induction process to continue.
  • If the fetal presenting part is not the fetal head and the fetus is not cephalic presentation, a member of medical staff must be paged to perform an ultrasound to identify fetal presentation and alter the patient’s care plan accordingly.

Documentation

  • All bedside ultrasounds MUST be documented on Badger.
  • This should be documented in the Induction of Labour section within the additional notes.
  • Report as “Butterfly USS confirms cephalic presentation prior to VE/PGE/CRB” or “Butterfly USS does not confirm cephalic presentation. Medical staff paged to review”.

Editorial Information

Last reviewed: 19/08/2024

Next review date: 19/08/2027

Author(s): Claire-Louise Kelly, Amy Sinclair.

Approved By: Maternity Governance Group