产程进展中超声监护的参数变化对剖宫产适应症提示作用的研究

Study on the Effect of Ultrasonic Monitoring Parameter Changes in the Indication of Cesarean Section during labor

目的:探究产程进展中超声参数变化对患者剖宫产适应症的提示作用,从而为尽早选择正确的分娩方式、减少产时及产后并发症的发生提供参考依据。方法:选取本服务中心住院分娩的孕妇500例作为本次研究对象,患者选取时间为2019年1月1日至2020年1月1日,分娩过程中所有产妇均由工作经验5年以上的助产士进行阴道指检,于患者宫口扩张2cm时行第1次B超检查,此后每隔1小时再次进行B超测量,应用Sono VCAD软件在图像A平面上测量产程进展角(AOP)和胎头下降距离(HPD),追踪随访所有孕妇的分娩方式,并根据不同的分娩阶段对于孕妇AOP角度与HPD差异进行分析对比。结果:本次研究发现,当孕妇宫口扩张3~4cm时,AOP≤120°的孕妇剖宫产发生率明显高于AOP>120°的孕妇剖宫产发生率,组间差异明显(χ^2=4.027,P=0.048);而当孕妇宫口扩张7~9cm时,AOP≤130°的孕妇剖宫产发生率明显高于AOP>130°的孕妇剖宫产发生率,组间差异明显(χ^2=8.062,P=0.003);当产妇进入第一产程后,HPD≤30mm的孕妇剖宫产发生率与HPD>30mm的孕妇剖宫产发生率基本无差别(χ^2=0.724,P=0.398);当产妇进入第二产程时HPD≤40mm的孕妇剖宫产发生率明显高于HPD>40mm的孕妇剖宫产发生率,组间差异明显(χ^2=5.724,P=0.018)。结论:在孕妇分娩的过程阶段中,通过超声评估产程中产程进展角和胎头下降距离,能够有效对于产妇的分娩方式选择提供参考依据。

Objective:To explore the effect of ultrasound parameter changes on the indications of cesarean section in the progress of labor,so as to provide a reference for choosing the correct delivery method as soon as possible and reducing the occurrence of complications during and after delivery.Methods:500 pregnant women who gave birth in hospital in this service center were selected as the research objects.The patients were selected from January 1,2019 to January 1,2020.During the delivery process,all the women who gave birth were midwives with more than 5 years of work experience Perform vaginal digital examination,perform the first B-ultrasound when the patient’s uterine orifice dilates 2 cm,and then perform B-ultrasound again every 1 hour.Use Sono VCAD software to measure the angle of labor progress(AOP)and the distance of head-up drop on the image A plane(HPD),follow up the delivery methods of all pregnant women,and analyze and compare the difference between the AOP angle and HPD of pregnant women according to different stages of delivery.Results:This study found that the incidence of cesarean section in pregnant women with AOP≤120°was significantly higher than the incidence of cesarean section in pregnant women with AOP>120°when the uterine opening was dilated by 3~4 cm,and the difference between the groups was significant(χ^2=4.027,P=0.048);when the uterine orifice was dilated by7~9 cm,the incidence of cesarean section in pregnant women with AOP≤130°was significantly higher than the incidence of cesarean section in pregnant women with AOP>130°,and the difference between the groups was significant(χ^2=8.062,P=0.003);when the mother enters the first stage of labor,the incidence of cesarean section in pregnant women with HPD≤30 mm is basically the same as that of pregnant women with HPD>30 mm(χ^2=0.724,P=0.398);When the mother entered the second stage of labor,the incidence of cesarean section in pregnant women with HPD≤40 mm was significantly higher than the incidence of cesarean section in pregnant women with HPD>40 mm,with significant differences between groups(χ^2=5.724,P=0.018).Conclusion:In the process of delivery of pregnant women,ultrasound assessment of the angle of progress of labor and the distance of head-up and down during labor can effectively provide a reference for the selection of delivery methods for women.