The following is a summary of “Real-time imaging as visual biofeedback in active second stage of labor among nulliparas: a randomized controlled trial,” published in the October 2023 issue of Obstetrics and Gynecology by Hamid, et al.

A prolonged second stage of labor, particularly in nulliparous women, is associated with various maternal and neonatal complications. Maternal pushing during this stage significantly contributes to the expulsive force facilitating fetal delivery. Preliminary findings suggested visual biofeedback, explicitly focusing on the perineum, may expedite the birthing process. For a randomized controlled trial conducted at the University Malaya Medical Centre from December 2021 to August 2022, researchers sought to assess whether visual feedback targeting the perineum could reduce the duration of the active second stage of labor compared to a control group.

Nulliparous women entering the active second stage, with term pregnancies, singleton gestation, reassuring fetal status, and no contraindications for vaginal delivery were enrolled. Participants were randomly assigned to receive live visual biofeedback of either the maternal introitus (intervention) or maternal face (sham/control) during pushing. A video camera, Bluetooth-linked to a tablet computer display screen, was employed, focusing on the introitus for the intervention group and the maternal face for the control group. Participants were instructed to observe the display screen during the pushing phase. Primary outcomes included the intervention-to-delivery interval and maternal satisfaction using a visual numerical rating scale (0-10). Secondary outcomes encompassed mode of delivery, perineal injury, delivery blood loss, birthweight, umbilical cord arterial blood pH, base excess at birth, Apgar scores at 1 and 5 minutes, and neonatal intensive care unit admission. Statistical analysis employed t-tests, Mann-Whitney U tests, chi-square tests, and Fisher exact tests as appropriate.

A total of 230 women were randomly assigned to the intervention (n=115) and control (n=115) arms. The median (interquartile range) duration of the active second stage (intervention-to-delivery interval) was 16 (11–23) minutes for the intervention group and 17 (12–31) minutes for the control group, revealing no statistically significant difference (P=.289). However, maternal satisfaction with the pushing experience was notably higher in the intervention group, with a median score of 9 (8–10), compared to 7 (6–7) in the control group (P<.001). Furthermore, women in the intervention arm were more likely to recommend their management to a friend (76.5% vs. 33.9%; relative risk, 2.26 [95% CI, 1.72–2.97]; P<.001) and demonstrated a lower incidence of severe perineal injury (P=.018).

The utilization of real-time visual biofeedback focusing on the maternal introitus during the pushing phase did not significantly reduce the time to delivery but resulted in significantly higher maternal satisfaction compared to the sham control, where the maternal face was observed. Additionally, the intervention group exhibited a greater likelihood of recommending their management and experienced less severe perineal injury.

Source: ajog.org/article/S0002-9378(23)00318-6/fulltext