Visual biofeedback for shortening the second stage of labor: randomized controlled trial

Abstract

ABSTRACTObjectiveTo examine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery.MethodsThis was a prospective, single‐center, randomized controlled trial. Nulliparous women under epidural anesthesia with full dilatation were randomized into the biofeedback and control groups (50 patients in each group). Both groups received coached maternal pushing during four consecutive contractions while an experienced obstetrician was performing transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing before and during the first and fourth contraction. Second stage duration and delivery outcomes were compared between the groups.ResultsVisual did not affect second stage duration (2.28 hours in the biofeedback group, IQR 1.25‐3.1, vs. 2.08 hours in the control group, IQR 1.58‐3.02, p = 0.981). AOP was significantly higher in the biofeedback group compared to the control group both at rest before the fourth contraction (142.6 ± 15.9 vs. 136.8 ± 13.1, respectively, p = 0.049) and while pushing during the fourth contraction (159.3 ± 19.2 vs. 149.4 ± 15.1, respectively, p = 0.005). Increase in AOP was significantly higher in the biofeedback compared to the control group in last push (16.6 ± 11 vs. 12.6 ± 8.3, respectively, p = 0.041) as well as total increase of AOP (24.4 ± 13.6 vs. 17.9 ± 11.3, respectively, p = 0.011). The overall rate of intact perineum was similar (12% vs. 8%, respectively, p=0.505).ConclusionsVisual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second stage duration, possibly due to the short duration of the intervention. Future studies should be focused on continuous intervention throughout the second stage of labor.This article is protected by copyright. All rights reserved.