第一产程活跃期经会阴超声对初产妇分娩方式的预测价值

魏玉新; 梁舒雯; 陈醇; 李秀玲; 朱姝; 颜芳

doi:10.12259/j.issn.2095-610X.S20220908

第一产程活跃期经会阴超声对初产妇分娩方式的预测价值

doi: 10.12259/j.issn.2095-610X.S20220908

云南省第一人民医院/昆明理工大学附属医院产科，云南昆明　650032

基金项目: 云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2019FE001（-290），2019FE001（-126），202001AY070001-123]；云南省医疗卫生单位内设研究机构基金资助项目（2018NS0239，2018NS0240）；云南省妇产疾病临床医学研究中心基金资助项目（202002AA100199，2022YJZX-FC19）

详细信息

作者简介:
魏玉新（1982～），女，云南建水人，在读硕士研究生，主治医师，主要从事产前超声诊断工作

通讯作者:
颜芳，E-mail：khyanfang@vip.sina.com

中图分类号: R714.3
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出版历程
- 收稿日期: 2022-05-07
- 网络出版日期: 2022-09-07
- 刊出日期: 2022-09-29

Prediction of Delivery Mode by Transperineal Ultrasound during the Active Phase of the First Stage Labor

Dept. of Obstetrics，The 1st People’s Hospital of Yunnan & Affiliated Hospital of Medical School, Kunming University of Science and Technology，Kunming Yunnan 650032，China

摘要

摘要: 目的探讨第一产程活跃期时产程进展角（angle of progression，AOP）、胎头下降距离（progression distance，PD）、胎头至耻骨联合距离（head-symphysis distance，HSD）等产程进展参数对分娩方式的预测价值。方法选取2020年7月到2021年12月在云南省第一人民医院产科经阴道试产的初产妇作为研究对象，在第一产程活跃期测量其AOP、PD、HSD，比较阴道分娩组与剖宫组之间上述参数的差异，应用ROC曲线分析各产程进展参数对孕妇分娩方式的预测价值。结果阴道分娩组孕妇在第一产程活跃期AOP及PD明显大于剖宫产组，[（141.09±9.87）° vs （122.84±10.70）°]、[（4.28±0.48） cm vs （3.18±0.83） cm]，而HSD阴道分娩组则明显小于剖宫产组[（1.42±0.40） cm vs（ 2.18±0.64） cm]，差异均有统计学意义（P < 0.001）；ROC曲线分析显示，AOP、PD、HSD预测阴道分娩的曲线下面积分别为0.892、0.875、0.840，差异均有统计学意义（P < 0.001）。结论对经阴道试产初产妇，第1产程活跃期AOP、PD及HSD的测量对分娩方式具有预测价值。
- 超声 /
- 产程 /
- 分娩方式 /
- 产程进展角 /
- 胎头下降距离 /
- 胎头至耻骨联合距离
Abstract: Objective To investigate the value of angle of progression progression （AOP）, fetal head descent distance （PD） and fetal head to pubic symphysis （HSD） in predicting the mode of delivery during the active phase of the first stage of labor. Methods The AOP, PD and HSD were measured at the active phase of the first stage of labor. The difference of these parameters was compared between the vaginal delivery group and the cesarean section group. Results The AOP and PD in vaginal delivery group were significantly higher than those in cesarean delivery group （141.09° ±9.87° vs 122.84° ±10.70° , 4.28 cm ± 0.48 cm vs 3.18 cm ± 0.83 cm）, while HSD in vaginal delivery group were significantly lower than that in cesarean delivery group （1.42 cm ± 0.40 cm vs 2.18 cm ± 0.64 cm）（P < 0.001）. The AUC of AOP, PD and HSD for predicting vaginal delivery was 0.892, 0.875 and 0.840, respectively, with statistical significance （P < 0.001）. Conclusion The measurement of AOP, PD and HSD in the active phase of the first stage of labor has the predictive value for the mode of delivery in nulliparous women.
- Ultrasound /
- Labor /
- Delivery mode /
- AOP /
- PD /
- HSD

HTML全文

图 1 经会阴超声测量

Figure 1. The measurement of AOP,PD and HSD by intrapartum translabial ultrasound A：AOP；B：PD；C：HSD。

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图 2 AOP、PD、HSD预测阴道分娩的ROC曲线

Figure 2. The ROC curve of AOP、 and HSD for predicting vaginal delivery

下载: 全尺寸图片幻灯片

表 1 阴道分娩组和剖宫产组之间一般情况的比较（$\bar x \pm s $）

Table 1. The difference of basic characteristics between the vaginal delivery group and the cesarean section group （$\bar x \pm s $）

临床特征	阴道分娩组	剖宫产组	t	P
年龄（岁）	28.67 ± 3.51	28.84 ± 4.12	−0.273	0.785
体重（kg）	67.90 ± 9.24	67.97 ± 6.78	−0.042	0.966
体重指数（kg/m²）	26.36 ± 3.40	26.93 ± 2.65	−1.021	0.309
胎儿头围（cm）	32.60 ± 1.17	33.02 ± 0.93	−2.234	0.027^*
出生体重（g）	3232 ± 396	3429 ± 378	−2.945	0.004^*
^* P < 0.05。

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表 2 阴道分娩组和剖宫产组之间各产程进展参数的比较（$\bar x \pm s $）

Table 2. The difference of labor progression parameters between the vaginal delivery group and the cesarean section group （$\bar x \pm s $）

组别	AOP（°）	PD（cm）	HSD（cm）
阴道分娩组（n = 158）	141.09 ± 9.87	4.28 ± 0.48	1.42 ± 0.40
剖宫产组（n = 44）	122.84 ± 10.70	3.18 ± 0.83	2.18 ± 0.64
t	10.64	11.25	−9.69
P	< 0.001^*	< 0.001^*	< 0.001^*
^*P < 0.05。

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表 3 产程进展参数对分娩方式（阴道分娩）的预测效能

Table 3. The value of these parameters in predicting the mode of delivery

产程进展参数	AUC	截断值	灵敏度（%）	特异度（%）	P	95%置信区间
产程进展参数	AUC	截断值	灵敏度（%）	特异度（%）	P	下限	上限
AOP	0.892	132.95°	80.4	86.4	< 0.001^*	0.833	0.951
PD	0.875	3.65 cm	90.5	68.2	< 0.001^*	0.816	0.934
HSD	0.840	1.75 cm	84.8	68.2	< 0.001^*	0.773	0.907
^*P < 0.05。

下载: 导出CSV

参考文献(19)

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