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The study will observe the effect of antenatal biofeedback with transperineal and abdominal ultrasound applied by a pelvic floor physical therapist. The training will focus on pelvic floor training and maternal-coached pushing with ultrasound-based visual biofeedback. The investigators aim to assess maternal and neonatal obstetrical outcomes, urinary and fecal incontinence, and maternal psychological effects.
Childbirth is a challenging process both emotionally and physically. The anxiety and anticipation accompanying pregnancy, labor, and delivery were reported to be relieved by pre-labor education, providing knowledge regarding the physiological process of labor to future parents.
Ultrasound examination enables the laboring women the opportunity to see fetal head movements in response to maternal pushing, and previous studies have revealed the physiological and psychological advantages of ultrasound-mediated intrapartum biofeedback during the second stage of labor.
Pre-labor sonographic maternal coaching has the advantage of a clean setting, avoiding the stressful, frequently hectic nature of labor and delivery wards, and may enable a more comprehensive implementation of the method, a structured training program, and better physical and psychological outcomes. All available literature regarding the application of intrapartum and pre-labor ultrasound refers to the examination performed by obstetricians.
The study will observe the effect of antenatal biofeedback with transperineal and abdominal ultrasound applied by a pelvic floor physical therapist. The training will focus on two aspects: pelvic floor training and maternal coached pushing - both with ultrasound-based visual biofeedback. The investigators aim to assess maternal and neonatal obstetrical outcomes, urinary and fecal incontinence, and maternal psychological outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Transabdominal ultrasound will be applied to optimize the training program of contracting pelvic floor muscles, aiming to decrease postpartum urinary and fecal incontinence. Transperineal ultrasound will be used for pre-labor-coached maternal pushing aiming to improve pushing during the second stage of labor, reduce operative deliveries, the incidence of perineal tears, and urinary and fecal incontinence. |
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| Control group | No Intervention | A pelvic floor physiotherapist will provide the participants with a verbal explanation of how to contract pelvic floor muscles. without ultrasound. | |
| Standard care | No Intervention | Questionnaires only at four timeline points - before delivery at recruitment (T0), a week later (T2), immediately postpartum (T3), and two months postpartum (T4) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pre-labor ultrasound as a visual biofeedback device for maternal pushing education and pelvic floor training | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| length of the second stage of labor | measure by time (min/hour) | up to 1 week after labor |
| Measure | Description | Time Frame |
|---|---|---|
| Mode of delivery | Number of Participants with spontaneous vaginal or operative delivery (operative assisted - vacuum-assisted, forceps assisted, cesarean delivery) | up to 1 week after labor |
| Perineal tears |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Noa Ben Ami, PhD | Ariel University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Noa Ben Ami | Ariel | 40700 | Israel |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41862837 | Derived | Ben-Ami N, Tischler T, Ruff SR, Hendin N, Hadar E, Rousseau S, Perlman S. Physiotherapist-led ultrasound-guided visual biofeedback prelabor training: a randomised controlled trial. BMC Pregnancy Childbirth. 2026 Mar 21;26(1):471. doi: 10.1186/s12884-026-08976-8. |
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Randomized controlled study
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The outcomes assessor will collect the data from the files without knowing the participant's groups (intervention/control/standard care)
|
Number of Participants with Perineal tears, specifically OASIS - obstetric anal sphincter Number of Participants with injuries
| up to 1 week after labor |
| Urinary and fecal incontinence | Number of Participants with Urinary and/ or fecal incontinence | up to 1 week after labor, and 2 month after labor. |
| Fear of birth questionnaire | 6-36, higher score mean worse outcome. | Baseline, a week later , 1 week after labor and two months after labor |