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Despite being the most common interventions, obstetric surgery (Caesarean section, instrumental delivery and perineal repair) has not any major technological developments since the 1970s when Ventouse suction cups were developed. Factors such as rising maternal age, fertility techniques, and more liberal use of Caesarean delivery have rendered obstetrics to now be an acute surgical specialty. Over a third of UK women deliver by Caesarean Section (>50% emergency); another one-fifth have an instrumental vaginal delivery with associated perineal repair.
There is little research on improving acute obstetric surgical care for the mother and fetus particularly in engineering, medical physics and imaging. Interventions rely on digital vaginal examination and assessment of fetal head position, cervical dilatation and advancement of the fetal head through the pelvis during birth. Last year the NHS Litigation Authority (NHSLA) spent £1,1 billion on clinical negligence claims, of which 41% (almost £1/2billion) was for obstetric claims, mainly paid to brain-damage in children as a result of complications during labour and delivery. Two most frequently encountered needs are: 1. Safer disimpaction of the fetal head at Caesarean section. 2. Manual rotation of the fetal head when there is malposition, in addition to or instead of ventouse or forceps.
Given the above laid out clinical need, we seek to design a new class of smart/sensorised surgical gloves that can be used regulate the manual force applied on the fetus during vaginal delivery. Using engineering expertise in high-resolution 3D printing and materials processing, an array of flexible force sensors will be integrated on surgical gloves and provide real time force feedback and tactile imaging of fetus. Such a sensorised (smart glove) will enable safe rotation of the fetus head into favourable position for either the mother to push it out or for simple extraction with ventouse or forceps, as opposed to rotating with instrument which might be detrimental to baby (e.g. scalp haemorrhage, facial palsy) and mother (pelvic floor injury).
The PhD student will work with supervisory team from UCL Engineering, UCL surgical and interventional to develop the smart surgical gloves. The clinical supervision team have lead role in UCLH and its role as a specialist centre for women with complex pregnancies and placental attachment disorders such as placental previa. Thus the current project will have a direct impact on improving the neonatal outcomes through new instruments to improve surgical delivery, and to reduce maternal morbidity.
The aim is to improve neonatal outcomes through new instruments to improve surgical vaginal delivery, and to reduce maternal morbidity.
Supervisors
Dr Manish Tiwari and Dr Adrien Desjardins
Dr Anna David
Dr Dimitrios Siassakos