不同分娩方式下胎头变形程度分析

Analysis of Deformation Degree of Fetal Head Under Different Delivery Modes

目的探讨胎头在分娩过程中的变形程度及超声检查诊断头位难产中的价值,为正确使用超声检查,识别头位难产提供理论依据.方法采用病例对照设计.选取云南省第二人民医院2015年7月至2016年10月分娩的,Labor Pro分娩监护系统无创测量,选取标准骨盆足月产妇260例进行分析.并排除产力、胎儿窘迫及社会因素.其中顺产孕妇149例,产钳46例,临产后因分娩异常剖宫产65例.比较3组在超声下胎儿双顶径,头围等相关指标变化的差异.并探讨以超声检查来评估头位难产的价值.结果难产组与顺产组超声指标双顶径,头围数值上差异有统计学意义(P<0.05).B超指标中的胎头双顶径,头围对难产的预测有价值.顺产组、产钳组及剖宫产组3组不同分娩方式下双顶径及头围的改变幅度差异有统计学意义(P<0.05).结论超声检查不能完全作为判断是否头盆不称的依据.研究表明不同分娩方式下存在胎头变形不一致的现象,因此临床评估头位难产需综合利用超声检查及其他相关临床检查.

Objective To analyze the presence of fetal deformation inconsistencies in different mode ofdelivery through evaluating the value of ultrasonography during the diagnosis of Cephalic presentation dystocia, andprovide a theoretical guide to early identify Cephalic presentation dystocia with the proper usage of ultrasound.Methods In the study,through a case-control design,total term maternal 260 cases were selected from the SecondPeople＇s Hospital of Yunnan Province from July 2015 to October 2016 deliveries which were normal pelvis. Thesepregnant women were measured by LaborPro Delivery monintoring system＇s noninvasive monitoring. Among thosecases excluding fetal distress and social factors,there were 149 cases of natural childbirth,46 cases of forcepsdeliveries and 65 cases of caesarean birth. Comparing the difference of the related indicators such as fetal biparietaldiameter,head circumference in three groups＇ data, the paper assessed the value and limitations of ultrasonographyfor identifying Cephalic presentation dystocia, and analyzed possible reasons of its limitations.Results In theseultrasound indicators, there were significant differences of BPD, head circumference, upper abdominalcircumference values between Dystocia group and Natural childbirth group（ P〈0.05） . B-ultrasonic indicators ofbiparietal diameter,head circumference provided valuable prediction for dystocia prediction. Natural childbirth,forceps deliveries and cesarean birth, there were some differences of BPD and the head circumference changing of theamplitude（ P〈0.05） . Conclusions The ultrasound can not be completely as a basis for judging cephalopelvicdisproportion. This study shows that the presence of fetal deformation inconsistencies in different mode of delivery.Therefore,Clinical evaluation of head-position dystocia requires comprehensive use of ultrasound and other relevantclinical examinations.