改良头位分娩评分法识别头位难产临床应用价值的研究

The clinical value of the modified scoring method for head-position delivery in the diagnosis of head-position dystocia.

目的:探讨改良头位分娩评分法用于识别头位难产的可行性及临床应用价值。方法:应用改良头位分娩评分法对625例足月分娩的初孕产妇适时评分,采取相应措施,选择正确分娩方式。结果:改良头位分娩评分法与头位分娩评分法比较,其识别头位难产的敏感性和特异性较高,误诊和漏诊较少。影响头位分娩的诸因素中先露下降、宫口扩张、胎位、宫缩强度、活跃期长短与难产相关性较大;改良法临产评分≤50分者, 69. 5%需行剖宫产术, >50分者, 94. 82%经阴道分娩,与头位分娩评分法比较,改良法与分娩结局更吻合;不同分娩方式处理后,改良法评分均有不同程度地提高,提高越明显,自然分娩几率越高。结论:改良头位分娩评分法将影响分娩的诸因素进行量化评分,能更及时、准确地判断头位顺产或难产,正确选择分娩方式,减少了产科并发症。

Objective:To explore the feasibility and value of the clinical practice of the modified scoring method in the diagnosis of head-position dystocia.Methods:Six hundred and twenty-five primiparas with head-position term delivery were chosen to apply this modified method.Results:The modified method had more sensitivity and specificity than the Lingluoda′s method in distinguishing dystocia.Delivery factors such as descent of fetal presentation,dilatation of cervix,fetal position,strength of uterine contraction,length of active phase were more closely related with dystocia.69.5% of the parturients with the scores of equal to or less than 50 took caesrean section,while 94.82% of the parturients with improved scores higher than 50 deliveried through vagina.The modified method was more accurate and fitter for delivery outcome than the Linluoda′s method of delivery;the higher the score was,the more opportunity the delivery did normaly.Conclusion: The modified method provides a quantitative score to the overall delivery factors,thus it is good for a better judgement on normal delivery or dystocia and choosing an appropriate way of delivery and decreasing the complication.