Traditionally <i>vs</i> sonographically coached pushing in second stage of labor: a pilot randomized controlled trial

Bellussi, Federica; Alcamisi, L.; Guizzardi, Giulia; Parma, Dila; Pilu, Gianluigi

doi:10.1002/uog.19044

Cited by 32 publications

(29 citation statements)

References 22 publications

(43 reference statements)

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“…The sonographic coaching group observed the progress of the fetal head on the screen, while the other group did not. The sonographic coaching group had a significantly shorter second stage of labor 23 . Gilboa et al have shown that women who received visual biofeedback during labor had a more effective pushing technique and felt a stronger connection to the newborn after birth 24 .…”

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 95%

“…Fetal head descent is visible on the ultrasound screen during examination and visual biofeedback may be a future option to guide women to push more effectively. In a randomized controlled pilot study, 40 women randomized to either sonographic coaching or traditional coaching underwent a transperineal ultrasound at the beginning of the active phase of pushing. The sonographic coaching group observed the progress of the fetal head on the screen, while the other group did not.…”

Section: Discussionmentioning

confidence: 99%

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Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery

Kahrs

Usman

Ghi

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. Methods This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head–perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. Results The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01–1.08). Mean ΔHPD was 7 mm (range, −10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5‐min Apgar score < 7 and ΔHPD quartile. Conclusion Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery

Kahrs

Usman

Ghi

et al. 2019

Ultrasound in Obstet & Gyne

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“…Such interventions may include ultrasound coaching by visual feedback which has been reported to be beneficial when used in the labor ward. 41,42…”

Section: Research Implicationsmentioning

confidence: 99%

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

Kamel

Montaguti

Nicolaides

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. OBJECTIVE: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. STUDY DESIGN: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. RESULTS: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r ¼ e0.230, P ¼ .021) and active second stage (r ¼ e0.338, P ¼ .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 AE 56 vs 28 AE 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158e3.752; P ¼ .014). There was no significant difference between women who underwent operative delivery (n ¼ 46) when compared with the spontaneous vaginal delivery group (n ¼ 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P ¼ .49). CONCLUSION: Levator ani coactivation is associated with a longer active second stage of labor.

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“…Given that informal literature reviews are frequently found to be selective and avoid contradictory studies, the gold standard for this process should be performing a formal systematic review prior to embarking on a new trial. Of three new trials of therapeutic interventions in obstetrics published in this journal last year, all made reference to prior work in their field but only one referred to a systematic review of the literature on the topic. Even in this study, the systematic review mentioned was published after the trial recruitment had ended, so clearly it was not used to inform the trial design.…”

Section: The Problem Of Research Waste In Obstetricsmentioning

confidence: 99%

Increasing value and reducing research waste in obstetrics: towards woman‐centered research

Townsend

Duffy

Khalil

2020

Ultrasound in Obstet & Gyne

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Traditionally vs sonographically coached pushing in second stage of labor: a pilot randomized controlled trial

Cited by 32 publications

References 22 publications

Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery

Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

Increasing value and reducing research waste in obstetrics: towards woman‐centered research

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