产时超声对产程评估的应用价值

Application value of intrapartum ultrasound for labor process evaluation

目的评价产时超声在分娩过程中评估产程的应用价值。方法选取2020年3月至6月在西安大兴医院产科行阴道试产的临产孕妇120例,由超声经会阴测量宫颈口扩张大小、胎头进展角(AoP)及胎头会阴距离(HPD),由经验丰富的助产医师经阴道触诊判断宫颈口扩张大小和胎先露最低点位置,2组人员评估过程中数据保持互盲,采用Pearson相关分析超声判断的宫颈口扩张大小与阴道触诊的宫颈口扩张大小的相关性,分析超声测量的AoP和HPD与胎先露最低点位置关系,使用受试者操作特征(ROC)曲线评估AoP和HPD预测自然分娩的效能。结果阴道触诊宫颈口与超声检查宫颈口大小成正相关(r=0.904,P<0.001)。随着胎头位置的下降,AoP逐渐增大,HPD逐渐减小。AoP预测自然分娩的ROC曲线下面积为0.699,敏感度为75%,特异度为60%,截点值为96.5°;HPD预测自然分娩的ROC曲线下面积为0.624,敏感度为48%,特异度为80%,截点值为36.5 mm。结论超声评估宫颈口扩张大小与阴道触诊结果基本符合,产时超声检测参数AoP和HPD可用于评估胎头下降位置,对预测分娩方式具有可行性。

Objective To analyze the application value of intrapartum ultrasound in evaluating the progression of labor.Methods A total of 120 pregnant women who underwent vaginal trial labor at the obstetrics department of Xi'an Daxing Hospital from March 2020 to June 2020 were selected.Cervical dilation size and fetal head angle of progression(AoP)and fetal head perineum distance(HPD)were measured by ultrasound.Experienced midwives performed vaginal palpation to determine the size of cervical dilation and the minimum point of fetal exposure.The data remained mutually blinded during the evaluation by both groups.Pearson correlation analysis was performed to determine the correlation between cervical dilation and the size of vaginal palpation,as well as between AoP and HPD and the lowest point of fetal first exposure.The performance of AoP and HPD in predicting natural delivery was assessed using the receiver operating characteristic(ROC)curve.Results Vaginal palpation of the cervix was positively associated with cervical size measured by ultrasound(r=0.904,P<0.001).As the fetal head position decreased,AoP gradually increased and HPD gradually decreased.Using a cut-off value of 96.5°,the area under the ROC curve of the AoP for predicting spontaneous delivery was 0.699,with a sensitivity of 75%and specificity of 60%.Using a cut-off value of 36.5 mm,the area under the ROC curve of the HPD for predicting natural birth was 0.624,with a sensitivity of 48%and specificity of 80%.Conclusion Ultrasonic assessment of cervical dilation is basically in line with the vaginal palpation results.The intrapartum ultrasound parameters AoP and HPD can be used to assess the position of fetal head descent,which is feasible to predict the mode of delivery.