Self-operated home ultrasound for pre-labor pushing training: a proof-of-concept study

To evaluate the feasibility and acceptability of self-operated home ultrasound for visual biofeedback training among nulliparous women, enabling visualization of fetal head descent and practice of second-stage pushing prior to labor.

This was a prospective feasibility study conducted within the framework of an ongoing randomized controlled trial. Term nulliparous women at 37-41 weeks' gestation underwent an in-hospital transperineal ultrasound session with visual biofeedback, including real-time assessment of the angle of progression. Participants were subsequently instructed to perform home training using a self-operated handheld ultrasound device. Ultrasound clips were recorded and reviewed offline. Feasibility outcomes included session completion rates, proportion of interpretable clips, and successful acquisition of AoP measurements. Acceptability was assessed through open-ended feedback and participants' reported willingness to recommend the intervention.

Thirty women were enrolled, of whom 25 (83%) completed at least one home training session. A total of 96 home sessions were recorded (median 3 per participant, IQR 1.0-Ff.0, range 0-10), of which 88 (92%) were interpretable for AoP analysis. Coached pushing efforts during home training resulted in measurable changes in AoP (mean ΔAoP 14.4° ± 8.8°). No device-related adverse events were reported.

Self-operated home transperineal ultrasound for visual biofeedback is feasible, safe, and well accepted for pre-labor pushing training. Participants were able to acquire interpretable images and engage effectively with the biofeedback process. These findings support further evaluation of this approach in larger studies assessing its impact on labor outcomes and its integration into telemedicine-based prenatal care.