分娩过程中超声测量耻骨联合间距的价值

Value of ultrasonic measurement of pubic symphysis distance during labor

目的探讨分娩过程中超声测量耻骨联合间距对预测耻骨联合分离(PSD)的应用价值。方法回顾性分析2021年6月至2022年7月在苏州市吴中人民医院及南通大学附属江阴医院分娩的孕妇260例,根据产后随访,按照是否确诊PSD将其划分为PSD组26例、正常孕妇组(对照组)234例。收集两组相关数据,包括分娩前7 d内胎儿的双顶径、股骨长,宫口未开时孕妇耻骨联合间距,分娩过程中第一产程宫口开至5 cm时耻骨联合间距,产后耻骨联合间距,孕妇的年龄、孕周、妊娠次数、胎儿出生体重。比较两组间以上参数的差异。应用Spearman相关分析法分析各项参数与产后PSD发生的相关性。采用Logistic回归分析确定各参数对产后PSD发生的预测价值。采用ROC曲线分析各参数预测PSD的诊断效能。结果PSD组胎儿出生体重,孕妇产次、临产前宫口未开时耻骨联合间距、第一产程耻骨联合间距、产后耻骨联合间距高于或大于对照组,差异有统计学意义(均P<0.05)。孕妇年龄与产后PSD的发生呈负相关(r_(s)=-0.152,P=0.014),胎儿出生体重,孕妇产次、临产前宫口未开时耻骨联合间距、第一产程耻骨联合间距测量与产后PSD的发生呈正相关(r_(s)=0.160、0.166、0.678、0.581,均P<0.05)。Logistic回归分析显示临产前耻骨联合间距增加将增加产后患PSD的风险,差异有统计学意义(OR=2506.028,95%CI=14.293~439402.630,P=0.003);第一产程时耻骨联合间距增加将增加产后患PSD的风险,差异有统计学意义(OR=10704.027,95%CI=33.830~3386803.429,P=0.002)。ROC曲线分析显示,临产前宫口未开时耻骨联合间距、第一产程耻骨联合间距对PSD诊断的曲线下面积分别为0.896、0.917,敏感性分别为0.731、0.885,特异性分别为0.940、0.829,对应的临界值分别为0.87 cm、1.06 cm。两参数联合对PSD诊断的曲线下面积为0.930,敏感性为0.885,特异性为0.876。结论分娩过程中超声测量耻骨联合间距能预测孕妇产后患PSD的发生,可以为产妇PSD的发生和治疗提供依据。

Objective To explore the application value of ultrasonic measurement of the pubic symphysis distance in predicting pubic symphysis diastasis(PSD)during delivery.Methods A total of 262 pregnant women from June 2021 to July 2022 who delivered at Suzhou Wuzhong People′s Hospital and Jiangyin People′s Hospital were retrospectively analyzed.The patients were divided into PSD group of 26 cases and normal pregnant women group(control group)of 234 cases according to whether or not PSD was confirmed during postpartum follow-up.Relevant data of the two groups were collected,including the biparietal diameter and femoral length of the fetus within 7 days before delivery,the pubic symphysis distance of pregnant women when the cervix was not dilated,pubic symphysis distance when the cervix dilated to 5 cm during the first stage of delivery,and the pubic symphysis distance after delivery,the age of the pregnant woman,the gestational week,the number of pregnancies,and the birth weight of the fetus.The differences of the above relevant data between the two groups were compared.Spearman correlation analysis was used to analyze the correlation between various parameters.The occurrence of postpartum PSD,and Logistic regression was used to analyze the predictive value of various parameters on the occurrence of postpartum PSD.ROC curve was used to analyze the diagnostic efficacy of each parameters to predict PSD.Results The fetal birth weight,number of pregnancies,pubic symphysis distance in three time points in the PSD group were significantly higher than those in the control group(all P<0.05).The age of the pregnant women was negatively correlated with the occurrence of postpartum PSD(r_(s)=-0.152,P=0.014).The fetal birth weight,the number of pregnancies,the pubic symphysis distance in the cervix no-dilated and the first stage of labor were positively correlated with the occurrence of postpartum PSD(r_(s)=0.160,0.166,0.678,0.581,all P<0.05).Logistic regression analysis showed that the increase of pubic symphysis distance before labor would increase the risk of postpartum PSD,and the difference was statistically significant(OR=2506.028,95%CI=14.293-439402.630,P=0.003).The increase of pubic symphysis distance at the first stage of labor increased the risk of postpartum PSD,with a statistically significant difference(OR=10704.027,95%CI=33.830-3386803.429,P=0.002).The ROC curve analysis showed that the area under the curve of the pubic symphysis distance in the cervix no-dilated and the first stage of labor for the diagnosis of PSD were 0.896 and 0.917 respectively,the sensitivity were 0.731 and 0.885,the specificity were 0.940 and 0.829,and the corresponding critical values were 0.87 cm and 1.06 cm respectively.The area under the curve of the combination of the two parameters for the diagnosis of PSD was 0.930,the sensitivity was 0.885,and the specificity was 0.876.Conclusions Ultrasonic measurement of pubic symphysis distance during delivery can predict the occurrence of postpartum PSD in pregnant women and can provide a basis for the occurrence and treatment of postpartum pubic symphysis separation in pregnant women.