Visual biofeedback using transperineal ultrasound in second stage of labor

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 69%

Section: Principal Findingsmentioning

confidence: 78%

Section: Principal Findingsmentioning

confidence: 78%

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confidence: 99%

See 3 more Smart Citations

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

Bellussi

Alcamisi

Guizzardi

et al. 2018

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

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.

New technique for automatic sonographic measurement of change in head–perineum distance and angle of progression during active phase of second stage of labor

Angeli

Conversano

Dall’Asta

et al. 2020

What are the novel findings of this work? We assessed the performance of a new automatic ultrasound technique for measurement of the change in head-perineum distance and angle of progression, two sonographic parameters that are highly predictive of fetal head station and mode of delivery, during the active phase of the second stage of labor. The algorithm proved to be as accurate as an experienced operator and to quickly provide the necessary measurements. What are the clinical implications of this work? The ability to calculate automatically the dynamic change in the most commonly used sonographic indices of fetal head station and progression may provide accurate and fundamental information to the clinician who is managing an obstructed or protracted second stage of labor, avoiding a time-consuming and technically challenging examination.