经会阴三维超声评估产程进展参数研究

A study on parameter of labor progression assessment with intrapartum three-dimensional transperineal ultrasound

目的探讨经会阴三维超声测量产程进展度数、胎头下降距离评估产程进展的可行性。方法选取2010年12月至2011年1月于我院行阴道试产的孕妇100例。其中经阴道分娩82例(自然分娩75例,阴道助产7例),剖宫产18例。于产程中对孕妇行经会阴三维超声检查,测量产程进展度数、胎头下降距离。采用线性回归分析分析产程进展度数、胎头下降距离与内诊检查胎先露最低点位置的关系;应用受试者操作特性曲线(ROC曲线)分析产程进展度数、胎头下降距离与孕妇分娩方式的关系;采用两独立样本t检验分析经阴道分娩和剖宫产孕妇产程进展度数变化速度、胎头下降速度差异。结果线性回归分析显示,产程进展度数、胎头下降距离均与内诊检查胎先露最低点位置呈明显的线性关系,线性回归方程分别为:Y产程进展度数=-6.747X+0.057(R2=0.582,P<0.001),Y胎头下降距离=-2.121X+0.074(R2=0.605,P<0.001)。ROC曲线分析显示,产程进展度数>125.5°,胎头下降距离>39.5mm时,孕妇经阴道分娩的可能性较大。经阴道分娩孕妇第一产程活跃期产程进展度数变化速度为(19.3±15.4)°/h,胎头下降速度为(14.6±12.2)cm/h,均高于剖宫产孕妇的(2.4±4.8)°/h、(2.7±4.7)cm/h,且差异均有统计学意义(t值分别为9.896、6.766,P均为0.000)。结论经会阴三维超声可用于产程进展监测。经会阴三维超声测量产程进展度数、胎头下降距离可为临床提供一个相对客观、简便、准确的评估产程进展的参考指标。

Objective To discuss the feasibility of progression angel and progression distance from three-dimensional transperineal ultrasound（TPU） to assess labor progression.Methods One hundred pregnant women who preferred to vaginal delivery in our hospital were included in this study.Eighty-two of them had vaginal deliveries（75 were spontaneous vaginal delivery and 7 were operative vaginal delivery）and 18 had cesarean sections.Three-dimensional TPU examinations were performed during the progression of labor.The progression angle and progression distance were measured.The relationship between the progression angle or progression distance and the fetal head station from digital examination was analyzed with linear regression.The relationship between the progression angle or progression distance and the delivery mode was analyzed by receive operating characteristic（ROC） curve. Differences of the rate of change in progression angle or progression distance in vaginal delivery and cesarean section were compared by two sample independent t test.Results There was a significant linear correlation between the progression angle or progression distance and the fetal head station from digital examination.The linear regression equations were：Y（progression angle）=-6.747X＋0.057（R2=0.582,P0.001）,Y（progression distance）=-2.121X＋0.074（R2=0.605,P0.001）.From ROC curve,the condition with an angle125.5°and a distance39.5 mm was always associated with subsequent vaginal delivery.In the active phase of first stage of labor,the change rate of progression angel and distance were（19.3±15.4）°/h and（14.6±12.2）cm/h in the vaginal delivery group,while the change rate of progression angel and distance were（2.4±4.8）°/h and（2.7±4.7）cm/h in the cesarean section group,respectively.There was a significant difference between the two parameters（t=9.896,6.766,both P=0.000）.Conclusions Three-dimensional TPU could be used in labor progress monitoring.It can provide an objective,simple and convenient and accurate assessment index for clinical labor monitor.