Jaufuraully, Shireen Rebecca Yi Xuan;
(2025)
Can we improve the prediction, process, and outcome of operative birth through advanced imaging, novel surgical tools, and training?
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
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.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Can we improve the prediction, process, and outcome of operative birth through advanced imaging, novel surgical tools, and training? |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | 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. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10205176 |
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