Effect of ultrasound-guided visual biofeedback performed by midwives on duration of second stage of labor: randomized controlled trial.
I Avrahami, A Bilitzky-Kopit, M Tarasov et al.
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In 30 seconds
This single-center randomized controlled trial evaluated transperineal ultrasound (TPUS)-guided visual biofeedback for coached pushing by midwives in nulliparous women with term singleton pregnancies receiving epidural analgesia. Among 327 participants, the mean second-stage duration was shorter with sonographic coaching than with traditional vaginal coaching (107 ± 59 min vs 132 ± 71 min; P = 0.001). Rates of second-degree or higher perineal tears and intrapartum fever were also lower, while mode of delivery and reported neonatal outcomes did not differ significantly.
Key findings
- Mean second-stage duration was 107 ± 59 min with TPUS-guided coaching versus 132 ± 71 min with traditional coaching (P = 0.001).
- Second-degree or higher perineal tears occurred in 65.4% versus 77.3% (P = 0.020).
- Intrapartum fever occurred in 8.9% versus 16.4% (P = 0.043).
- Mode of delivery and neonatal birth weight and 5-min Apgar score did not differ significantly between groups.
Why it matters
Visualizing fetal-head movement during pushing may help women receiving epidural analgesia coordinate their efforts, and this trial found shorter second stages alongside lower rates of some maternal complications. The absence of a detected difference in delivery mode or reported neonatal outcomes is also relevant when interpreting the potential benefits. Further evidence is needed to establish how broadly these findings apply.
What to keep in mind
The trial was conducted at a single center and enrolled a defined population of nulliparous women with term singleton pregnancies receiving epidural analgesia. The authors state that larger studies are warranted.