Metrics of perineal support (MOPS) study

Abstract

Background: Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP. Methods: Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPP. Results: Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall mean values of the average and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later. Conclusions: MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.

A sensorised surgical glove to improve training and detection of obstetric anal sphincter injury: A preclinical study on a pig model

“…21 Another work measured the force applied during perineal support during childbirth. 22 However, to our knowledge, no sensorised gloves have been used for diagnostic purposes in obstetrics or maternity care. We have developed a novel, surgical glove that shows promise in detecting anal sphincter defects.…”

“…Sensorised gloves have been used in other obstetric applications, such as measuring the force applied on the maternal abdomen during external cephalic version (ECV) with a glove mounted with piezoresistive pressure sensors 21 . Another work measured the force applied during perineal support during childbirth 22 . However, to our knowledge, no sensorised gloves have been used for diagnostic purposes in obstetrics or maternity care.…”