Ultrasound biofeedback shortened second-stage labor in randomized trial

In a single-center randomized controlled trial of 327 nulliparous women receiving epidural analgesia, midwife-led transperineal ultrasound biofeedback was compared with traditional pushing coaching. The ultrasound group had a shorter second stage, while mode of delivery and selected neonatal outcomes did not differ significantly.

Randomized trial included 327 nulliparous women with epidural analgesia.
Ultrasound biofeedback shortened mean second-stage duration by 25 minutes.
Perineal tears and intrapartum fever were less frequent in the intervention group.
Mode of delivery did not differ significantly between groups.

The trial enrolled 327 nulliparous women with singleton term pregnancies receiving epidural analgesia at one center between May 2021 and August 2024. Participants were randomized to midwife-led coaching with real-time transperineal ultrasound visual feedback or traditional vaginal coaching. The primary outcome was duration of the second stage of labor.

Mean second-stage duration was 107 minutes (SD 59) with ultrasound-guided coaching and 132 minutes (SD 71) with traditional coaching (P=0.001). Second-degree or higher perineal tears occurred in 65.4% versus 77.3% (P=0.020), and intrapartum fever in 8.9% versus 16.4% (P=0.043), respectively. Mode of delivery and other reported secondary outcomes, including birth weight and 5-minute Apgar score, did not differ significantly.

The findings suggest that visual biofeedback delivered by midwives may improve labor progress in this specific population. The single-center design and limited sample size constrain generalizability; the authors call for larger studies. The abstract reports no significant difference in delivery mode, and the findings do not establish that the approach should replace traditional coaching.

In practice

For nulliparous women with singleton term pregnancies receiving epidural analgesia, one single-center randomized trial found that midwife-led transperineal ultrasound visual biofeedback was associated with a shorter second stage and fewer second-degree or higher perineal tears and cases of intrapartum fever than traditional coaching. Delivery mode and reported neonatal outcomes did not differ significantly. These findings are promising but do not establish that the approach should replace traditional coaching; the trial included 327 women at one center, and larger studies are needed to assess delivery outcomes and applicability elsewhere.

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Source

Ultrasound in Obstetrics & Gynecology: Effect of ultrasound‐guided visual biofeedback performed by midwives on duration of second stage of labor: randomized controlled trial ↗

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