Department of Medical and Surgical Sciences, Obstetric and Gynecologic Unit, University of Bologna, Bologna, Italy.
Ultrasound Obstet Gynecol. 2018 Jul;52(1):87-90. doi: 10.1002/uog.19044. Epub 2018 May 30.
To investigate the usefulness of visual biofeedback using transperineal ultrasound to improve coached pushing during the active second stage of labor in nulliparous women.
This was a randomized controlled trial of low-risk nulliparous women in the active second stage of labor. Patients were allocated to either coached pushing aided by visual demonstration on transperineal ultrasound of the progress of the fetal head (sonographic coaching) or traditional coaching. Patients in both groups were coached by an obstetrician for the first 20 min of the active second stage of labor and, subsequently, the labor was supervised by a midwife. Primary outcomes were duration of the active second stage and increase in the angle of progression at the end of the coaching process. Secondary outcomes included the incidence of operative delivery and complications of labor.
Forty women were recruited into the study. Those who received sonographic coaching had a shorter active phase of the second stage (30 min (interquartile range (IQR), 24-42 min) vs 45 min (IQR, 39-55 min); P = 0.01) and a greater increase in the angle of progression (13.5° (IQR, 9-20°) vs 5° (IQR, 3-9.5°); P = 0.01) in the first 20 min of the active second stage of labor than did those who had traditional coaching. No differences were found in the secondary outcomes between the two groups.
Our preliminary data suggest that transperineal ultrasound may be a useful adjunct to coached pushing during the active second stage of labor. Further studies are required to confirm these findings and better define the benefits of this approach. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
探讨经会阴超声引导下视觉生物反馈在初产妇活跃期第二产程中指导用力的作用。
这是一项针对活跃期第二产程低危初产妇的随机对照试验。患者被分为经会阴超声引导下视觉演示胎儿头部进展的指导用力组（超声指导组）或传统指导组。两组患者在活跃期第二产程的前 20 min 均由产科医生指导用力，之后由助产士进行监督。主要结局指标为活跃期第二产程时间和指导用力结束时进展角度的增加。次要结局指标包括剖宫产率和分娩并发症。
共招募 40 名产妇进入研究。接受超声指导组的产妇活跃期第二产程时间更短（30 min（四分位距（IQR），24-42 min）vs 45 min（IQR，39-55 min）；P=0.01），指导用力的前 20 min 时进展角度增加更大（13.5°（IQR，9-20°）vs 5°（IQR，3-9.5°）；P=0.01）。两组在次要结局方面无差异。
我们的初步数据表明，经会阴超声可能是活跃期第二产程指导用力的有用辅助手段。需要进一步的研究来证实这些发现，并更好地确定这种方法的益处。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
