产时超声在第二产程延长中对分娩方式的指导及对母婴结局的影响

Effect of intrapartum ultrasound on the guidance of delivery mode and maternal and infant outcome in the extension of the second stage of labor

目的探讨产时超声在第二产程延长中对产妇分娩方式的指导及其对母婴结局的影响。方法选择262例产妇为研究对象,经会阴二维超声检测胎头进展角(AOP)、胎头-会阴距离(HPD)及宫口扩张大小,记录产妇分娩时间及分娩结局,分析AOP、HPD对自然分娩的预测价值,对比不同产时超声特征产妇分娩方式及分娩时长的差异。结果与自然分娩产妇比较,助产及剖宫产组产妇AOP显著降低,胎方位非枕前位比例显著增加(P<0.05)。AOP和HPD均对阴道自然分娩具有一定的预测价值(AUC>0.7),最佳截断值分别为124.77°和4.62 cm。AOP>135°产妇自然分娩率显著高于AOP≤135°产妇,HPD≤4 cm产妇自然分娩率显著高于HPD>4 cm产妇(P<0.001)。AOP>135°产妇分娩时长显著低于AOP≤135°产妇(P<0.05),HPD≤4 cm产妇分娩时长显著低于HPD>4 cm产妇(P<0.05)。结论第二产程应用产时超声测量AOP和HPD可评估分娩方式及分娩时长,有助于提高分娩期母婴安全程度。

Objective To investigate the guidance of delivery mode and its effect on maternal and infant outcomes by intrapartum ultrasound in the prolongation of the second labor stage.Methods 262 parturients were selected as the study subjects,the angle of progression(AOP),head-perineum distance(HPD)and uterine expansion were detected by perineal ultrasound.The delivery time and delivery outcome were recorded,the predictive value of AOP and HPD in natural delivery was analyzed,and the differences of delivery mode and delivery time of parturients with different ultrasonic characteristics were compared.Results Compared with natural delivery,AOP of midwifery and cesarean section group decreased significantly,and the proportion of non occipital anterior fetal orientation increased significantly(P<0.05).AOP and HPD have certain predictive value for vaginal spontaneous delivery(AUC>0.7),and the best cutoff values are 124.77°and 4.62 cm,respectively.The natural delivery rate of women with AOP>135°was significantly higher than that of women with AOP≤135°,and the natural delivery rate of women with HPD≤4 cm was significantly higher than that of women with HPD>4 cm(P<0.001).The delivery time of women with AOP>135°was significantly lower than that of women with AOP≤135°(P<0.05),and that of women with HPD≤4 cm was significantly lower than that of women with HPD>4 cm(P<0.05).Conclusions The measurement of AOP and HPD by intrapartum ultrasound in the second stage of labor can evaluate the mode of delivery and the length of delivery,which is helpful to improve the safety of mothers and infants during delivery.