床旁超声在产检中预测足月分娩时机和方式的应用研究

Study on the application of bedside ultrasound in predicting the timing and mode of full-term delivery in prenatal examination

目的探讨床旁超声(腹部超声+会阴超声)检查预测足月分娩时机和方式的应用价值。方法回顾性分析2022年3月~2023年8月在佛山顺德爱博恩妇产医院建档产检并进行分娩的57例孕妇的临床资料,按实际分娩方式分为顺产组(n=48)和剖宫产组(n=9)。所有孕妇在孕后期进行腹部超声+会阴超声检查,根据超声监测指标对分娩时机和方式进行预测和干预,并将预测结果与实际临产时间和分娩方式进行对比分析。结果主要监测指标单因素分析显示,两组差异无统计学意义(P>0.05);多因素Logistic回归分析表明,各监测指标对实际分娩方式无显著影响(P>0.05),各监测指标联合预测顺产的曲线下面积(Area under the curve,AUC)具有统计学意义(P=0.032<0.05);根据腹部超声+会阴超声检查结果预测分娩孕周均与实际分娩孕周相符,准确度为100%,预测分娩方式的准确度为91.38%,根据腹部超声+会阴超声预测结果进行干预的得当率为92.98%。结论床旁超声监测胎头下降距离、胎头-会阴距离、产程进展角和宫颈长度可以作为联合预测顺产的重要参考指标。各指标联合分析对临床预测分娩时机和选择分娩方式有指导作用,在预防产科紧急手术和控制分娩风险方面具有一定作用。

Objective To study the predictive value of prenatal bedside ultrasound(transabdominal+perineum ultrasonography)in the timing and mode of full-term delivery.Methods A total of 57 pregnant women who were registered for prenatal examination and delivery in Foshan Shunde iBorn Wonmen’s&Children’s Hospital from March 2022 to August 2023 were retrospectively analyzed.According to the actual delivery mode,they were divided into normal birth group(n=48)and cesarean section group(n=9).All pregnant women were examined by transabdominal+perineum ultrasnography examinations in the late pregnancy.According to the ultrasonic monitoring indicators,the timing and mode of delivery were predicted and intervened,and the prediction results were compared and analyzed with the actual labor time and mode of delivery.Results The univariate analysis of the main monitoring indicators was not statistically significant between the two groups(P>0.05).Multivariate Logistic regression analysis showed that there was no significant effect on the actual mode of delivery(P>0.05),but the area under the curve(AUC)of the combined prediction of each monitoring index was statistically significant(P=0.032<0.05).The predicted gestational age of delivery by transabdominal+perineum ultrasonography was consistent with the actual gestational age of delivery,the accuracy rate was 100%.The accuracy rate of predicting delivery mode was 91.38%.The appropriate rate of intervention based on the predicted results of abdominal ultrasound+perineal ultrasound was 92.98%.Conclusion Bedside ultrasonography monitoring of fetal head progression distance,head-perineal distance,angle of progression and cervical length can be used as important reference indicators for the prediction of delivery mode.The combined analysis of all indicators has a guiding role in predicting the time of delivery and selecting the mode of delivery,and has a certain role in preventing emergency obstetric surgery and controlling the risk of delivery.