Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Ha-Shomer, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ultrasound Obstet Gynecol. 2018 Jul;52(1):91-96. doi: 10.1002/uog.18962. Epub 2018 May 29.
To assess the obstetric and psychological effects of visual biofeedback by transperineal ultrasound (TPU) during the second stage of labor.
This was a prospective, single-center observational study of low-risk nulliparous women with epidural analgesia undergoing vaginal delivery. Visual biofeedback using TPU was provided to 26 women during the second stage of labor. Pushing efficacy was assessed by the change in the angle of progression (AoP) at rest and during pushing efforts, before and after biofeedback. Obstetric outcomes included incidence of perineal tearing, mode of delivery and length of second stage of labor. Psychological outcomes were assessed by self-reported measures obtained during the postnatal hospital stay and included measures of perceived control and maternal satisfaction with childbirth, as well as level of maternal feelings of connectedness with the newborn. Obstetric and psychological results were compared with those of a control group of 69 women who received standard obstetric coaching from midwives.
Pushing efficacy increased significantly following visual biofeedback by TPU (P = 0.01), as indicated by a significantly lower delta AoP before (mean, 22.2° (95% CI, 13.9-31.7°)) compared with after (mean, 35.2° (95% CI, 25.9-45.3°)) biofeedback. A significant association was found between visual biofeedback and an intact perineum following delivery (P = 0.03). No significant differences were found between the two groups with regard to mode of delivery or length of the second stage. Feelings of maternal connectedness with the newborn were significantly stronger (P = 0.003) in women who received visual biofeedback than in those who did not. However, perceived control during childbirth and maternal satisfaction with childbirth did not differ significantly between the biofeedback and control groups.
This pilot study suggests that biofeedback using TPU may serve as a complementary tool to coached maternal pushing during the second stage of labor, with obstetric as well as psychological benefits. Further studies are required to confirm our findings and define the optimal duration of the intervention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
评估经会阴超声（TPU）在第二产程中进行视觉生物反馈对产妇和心理的影响。
这是一项前瞻性、单中心、观察性研究，纳入 26 名接受硬膜外镇痛行阴道分娩的低危初产妇。在第二产程中为这些产妇提供 TPU 视觉生物反馈。通过休息和用力时进展角（AoP）的变化来评估用力效果，在生物反馈前后进行评估。产科结局包括会阴撕裂的发生率、分娩方式和第二产程的长度。通过产妇在产后住院期间的自我报告评估心理结局，包括产妇对分娩的控制感和满意度的测量，以及产妇与新生儿的连接感的水平。将产科和心理结果与接受助产士标准产科指导的 69 名对照组产妇的结果进行比较。
TPU 视觉生物反馈后，产妇用力效果显著提高（P=0.01），表现为生物反馈前（平均，22.2°（95%CI，13.9-31.7°））AoP 明显低于生物反馈后（平均，35.2°（95%CI，25.9-45.3°））。生物反馈与分娩后会阴完整之间存在显著关联（P=0.03）。两组在分娩方式和第二产程长度方面无显著差异。与未接受生物反馈的产妇相比，接受视觉生物反馈的产妇对新生儿的母亲连接感更强（P=0.003）。然而，在分娩期间的控制感和对分娩的满意度方面，生物反馈组与对照组之间无显著差异。
这项初步研究表明，TPU 生物反馈可能是第二产程中指导产妇用力的补充工具，具有产科和心理方面的益处。需要进一步的研究来证实我们的发现并确定干预的最佳持续时间。
