Biofeedback for Second Stage of Labor

NCT04210908 — Not applicable, Completed, 100 participants, Assuta Ashdod Hospital

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Ultrasound Imaging Biofeedback for Shortening the Second Stage of Labor: a Randomized Prospective Study

RegistryNCT04210908
StatusCompleted
PhaseNot applicable
Study typeInterventional; randomized, parallel, masking: none, treatment
Enrollment100 (Actual)
SponsorAssuta Ashdod Hospital (Other)
ConditionsLabor Long, Labour;Obstructed
InterventionsVisual biofeedback (Other)
Datesstart 2020-04-30, primary completion 2022-11-19, completion 2022-11-25, first posted 2019-12-26, last updated 2022-11-30
Locations1 site in Israel

Related Papers Related Patents Related Grants Related Experts
All trials for Labor Long All trials for Labour;Obstructed All trials of Visual biofeedback

-Summary

The purpose of this study is to examine whether transperineal ultrasound as visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery, in a prospective randomized design.

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+Detailed description

Biofeedback provides patients with better control of their body and their physiological reactions respective of the examined process, such as stress/anxiety, sports activity, labor, etc.

Women under epidural anesthesia, may frequently feel lack of control over the birthing process and difficulty in bearing down effectively, which is a very significant part of the second stage of labor.

Transperineal ultrasound during labor is a standard procedure in many medical centers in the world, mainly used to assist obstetricians in evaluating the progress of labor, fetal head position and assessing the chances of successful operative delivery. One of the most common tools used in transperineal ultrasound in measurement of the angle of progression, which has been suggested as a subjective method for assessing fetal station and for predicting successful vaginal delivery. A preliminary non-randomized study raised the possibility that the use of transperineal ultrasound during labor as a biofeedback tool may shorten the second stage of labor.

The purpose of this study is to examine whether this tool can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery, in a prospective randomized design.

+Arms and interventions

ArmTypeInterventionsDescription
BiofeedbackExperimentalOther: Visual biofeedbackThe patient will be instructed to bear down during 4 consecutive contractions while monitoring head descent using transperineal ultrasound. In the study group, patients will observe the descent of the head during contraction on the ultrasound display screen.
ControlNo interventionThe patient will be instructed to bear down during 4 consecutive contractions while monitoring head descent using transperineal ultrasound. In the control group, patients will not observe the ultrasound display screen.
  • Visual biofeedback (Other): Patient will observe the descent of the fetal head as they push during contractions

+Outcome measures

Primary outcomes

  • Duration of the second stage of labor [Up to 6 hours]: Minutes from first documentation of full dilatation to delivery.

Secondary outcomes

  • Mode of delivery [Up to 6 hours]: Mode of delivery (categorical): spontaneous vaginal, operative vaginal or cesarean
  • Neonatal 1 minute Apgar score [Up to 6 hours]: Apgar score at 1 minute after delivery (scale of 0-10)
  • Neonatal 5 minute Apgar score [Up to 6 hours]: Apgar score at 5 minute after delivery (scale of 0-10)
  • Cord pH [Up to 6 hours]: Umbilical cord blood pH
  • Postpartum hemorrhage [Up to 24 hours]: Rate of early postpartum hemorrhage (during first 24 hours)
  • Maternal perineal tears [Up to 6 hours]: Maternal perineal tear grade (categorical): None and grades 1-4

+Eligibility

Sex: Female, ages: 18 Years to 45 Years, accepts healthy volunteers

Inclusion Criteria:

1. First labor
2. Full dilation
3. Head position between SP-1 and SP+2.
4. Epidural anesthesia
5. No contraindication for vaginal delivery
6. Parturient informed consent

Exclusion Criteria:

1. Participation in parallel studies.
2. Category III fetal monitoring requiring immediate delivery.

+Locations (1)

FacilityCityCountryStatus
Assuta Ashdod HospitalAshdodIsrael

+Publications

  • Kalache KD, Duckelmann AM, Michaelis SA, Lange J, Cichon G, Dudenhausen JW. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the 'angle of progression' predict the mode of delivery? Ultrasound Obstet Gynecol. 2009 Mar;33(3):326-30. doi: 10.1002/uog.6294. PMID 19224527
  • Gilboa Y, Frenkel TI, Schlesinger Y, Rousseau S, Hamiel D, Achiron R, Perlman S. Visual biofeedback using transperineal ultrasound in second stage of labor. Ultrasound Obstet Gynecol. 2018 Jul;52(1):91-96. doi: 10.1002/uog.18962. Epub 2018 May 29. PMID 29155474
  • Diegmann EK, Andrews CM, Niemczura CA. The length of the second stage of labor in uncomplicated, nulliparous African American and Puerto Rican women. J Midwifery Womens Health. 2000 Jan-Feb;45(1):67-71. doi: 10.1016/s1526-9523(99)00019-7. PMID 10772737
  • Levy R, Zaks S, Ben-Arie A, Perlman S, Hagay Z, Vaisbuch E. Can angle of progression in pregnant women before onset of labor predict mode of delivery? Ultrasound Obstet Gynecol. 2012 Sep;40(3):332-7. doi: 10.1002/uog.11195. PMID 22605649

+Investigators