宫颈后角和进展角预测引产后阴道分娩的临床价值

Clinical value of cervical posterior horn and progression angle in predicting vaginal delivery after induced labor

目的 应用经会阴超声测量宫颈后角和进展角,探讨其预测妊娠足月初产妇使用地诺前列酮栓引产后阴道分娩的临床价值。方法 前瞻性选取于我院接受引产且Bishop评分<4分的妊娠足月初产妇,均使用地诺前列酮栓促宫颈成熟引产,根据引产结局分为阴道分娩组和剖宫产组,比较两组引产前一般资料及超声指标的差异;采用多因素Logistic回归分析预测引产后阴道分娩的独立影响因素;绘制受试者工作特征(ROC)曲线分析其预测效能。结果 共纳入381例初产妇,分为阴道分娩组335例和剖宫产组46例。与剖宫产组比较,阴道分娩组产妇年龄更小,宫颈更短,宫颈后角及进展角更大,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,校正年龄因素后,宫颈后角和进展角均为预测引产后阴道分娩的独立影响因素(OR=0.948、0.995,均P<0.05)。ROC曲线分析显示,宫颈后角预测引产后阴道分娩的曲线下面积为0.843(95%可信区间:0.782~0.904),高于进展角的曲线下面积[0.652(95%可信区间:0.554~0.750)],差异有统计学意义(P=0.001)。结论 对于Bishop评分<4分的妊娠足月初产妇,宫颈后角和进展角均为预测引产后阴道分娩的独立影响因素,且宫颈后角的预测效能更好。

Objective To measure the cervical posterior horn and progression angle by transperineal ultrasound,and to investigate the clinical value in predicting vaginal delivery after induced labor with dinoprostone thrombus in pregnant term primiparous women with full-term pregnancy.Methods Full-term primiparous women who underwent induced labor in our hospital with Bishop score of<4 points were prospectively selected.The dinoprostone thrombus was used to induce cervical ripening induction of labor.They were divided into vaginal delivery group and cesarean section group according to the outcome of induction,the differences of general date and ultrasonic indicators before induced labor were compared.The independent influencing factors for predicting vaginal delivery after induced labor were analyzed by multi-factor Logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to evaluate its predictive efficacy.Results A total of 381 primiparous women were included,335 cases in the vaginal delivery group and 46 cases in the cesarean section group.Compared with the cesarean section group,the maternal age in the vaginal delivery group was younger,the cervix was shorter,and the posterior cervical horn and progression angle were larger,the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the posterior cervical horn and the progression angle were independent influencing factors of vaginal delivery after induced labor by adjusting for age factor(OR=0.948,0.995,both P<0.05).ROC curve analysis showed that the area under the curve of posterior cervical horn in predicting vaginal delivery after induced labor was 0.843(95%confidence interval:0.782~0.904),which was higher than that of progression angle[0.652(95%confidence interval:0.554~0.750)],and the differences was statistically significant(P=0.001).Conclusion For full-term primiparous women with Bishop score<4 points,the posterior cervical horn and progression angle are independent influencing factors of vaginal delivery after induced labor,and the predictive efficacy of the posterior cervical horn is better.