%0 Thesis
%9 Doctoral
%A Jaufuraully, Shireen Rebecca Yi Xuan
%B Institute for Women's Health
%D 2025
%F discovery:10205176
%I UCL (University College London)
%P 321
%T Can we improve the prediction,  process, and outcome of  operative birth through advanced  imaging, novel surgical tools, and  training?
%U https://discovery.ucl.ac.uk/id/eprint/10205176/
%X Childbirth is one of the most important moments of a person’s life. Operative vaginal   birth (OVB) and caesarean section (CS) account for a large proportion of these births,  and can carry significant risk to both the mother and neonate if not performed by skilled   practitioners. Despite how common operative birth is, the ability to predict mode of   birth, and to appropriately counsel patients, still eludes Obstetricians. Furthermore,   although various imaging techniques, such as ultrasound scan, can predict the   success of OVB, there are no intrapartum tools to aid in performing such deliveries.   Rates of OVB are decreasing whilst rates of second stage CS are increasing. It is   thought that a decrease in trainee exposure, as well as in confidence, are significant   contributors to such trends. Lack of skills or confidence in supervision likely compound   the problem.  The work presented in this thesis therefore aimed to explore whether magnetic   resonance imaging and pelvimetry/fetal biometry could predict mode of birth, and   whether a novel imaging protocol in late third trimester was feasible. In a collaboration   between Engineers and Obstetricians, we also explored whether a novel sensorised   glove could aid in OVB by diagnosing fetal position and anal sphincter injury. A new  practical course on OVB and complex CS was developed, aimed to increase   confidence levels of senior trainees.   This thesis found no pelvimetry/biometry values can accurately predict mode of birth  at present, but a novel imaging protocol, with the addition of markers of placental   function, is feasible in late third trimester, and should be tested in a large scale study.   Furthermore, although we cannot currently predict mode of birth, the novel sensorised   glove shows promise in improving the safety and success of OVB. A new course on   OVB significantly improved trainee confidence levels. It remains to be seen if we can   improve the prediction of OVB. With clinical translation of the novel sensorised glove,   and enhanced training for senior trainees, the future of OVB is positive.
%Z Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.