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Traditionally vs sonographically coached pushing in second stage of labor: a pilot randomized controlled trial
Author(s) -
Bellussi F.,
Alcamisi L.,
Guizzardi G.,
Parma D.,
Pilu G.
Publication year - 2018
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19044
Subject(s) - medicine , coaching , interquartile range , randomized controlled trial , obstetrics , stage (stratigraphy) , obstetrics and gynaecology , biofeedback , physical therapy , pregnancy , surgery , paleontology , biology , genetics , management , economics
Objective To investigate the usefulness of visual biofeedback using transperineal ultrasound to improve coached pushing during the active second stage of labor in nulliparous women. Methods This was a randomized controlled trial of low‐risk nulliparous women in the active second stage of labor. Patients were allocated to either coached pushing aided by visual demonstration on transperineal ultrasound of the progress of the fetal head (sonographic coaching) or traditional coaching. Patients in both groups were coached by an obstetrician for the first 20 min of the active second stage of labor and, subsequently, the labor was supervised by a midwife. Primary outcomes were duration of the active second stage and increase in the angle of progression at the end of the coaching process. Secondary outcomes included the incidence of operative delivery and complications of labor. Results Forty women were recruited into the study. Those who received sonographic coaching had a shorter active phase of the second stage (30 min (interquartile range (IQR), 24–42 min) vs 45 min (IQR, 39–55 min); P = 0.01) and a greater increase in the angle of progression (13.5° (IQR, 9–20°) vs 5° (IQR, 3–9.5°); P = 0.01) in the first 20 min of the active second stage of labor than did those who had traditional coaching. No differences were found in the secondary outcomes between the two groups. Conclusion Our preliminary data suggest that transperineal ultrasound may be a useful adjunct to coached pushing during the active second stage of labor. Further studies are required to confirm these findings and better define the benefits of this approach. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.